Provider Demographics
NPI:1689707895
Name:WAHBA, SAFWAT W (MD)
Entity Type:Individual
Prefix:
First Name:SAFWAT
Middle Name:W
Last Name:WAHBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 W PARK ST
Mailing Address - Street 2:SUITE C160
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2334
Mailing Address - Country:US
Mailing Address - Phone:217-337-2808
Mailing Address - Fax:217-337-2491
Practice Address - Street 1:1400 W PARK ST
Practice Address - Street 2:SUITE C160
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2334
Practice Address - Country:US
Practice Address - Phone:217-337-2808
Practice Address - Fax:217-337-2491
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
742290Medicare ID - Type Unspecified
C47359Medicare UPIN