Provider Demographics
NPI:1669491320
Name:HALABI, SAFWAN SAFAR (MD)
Entity Type:Individual
Prefix:
First Name:SAFWAN
Middle Name:SAFAR
Last Name:HALABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4007
Mailing Address - Country:US
Mailing Address - Phone:650-814-1561
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-2529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH877142085P0229X
KS04336042085R0202X
CODR.00487682085P0229X
MI43010785582085R0202X
MO20090025112085R0202X
CAA1050032085R0202X
IL0361196902085U0001X, 2085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000545197OtherANTHEM - KCR
KY7100027560Medicaid
KY92160OtherSIHO - KCR
KY50017560OtherPASSPORT - KCR
KY000000545197OtherANTHEM - KCR