Provider Demographics
NPI:1730101627
Name:WAEL GIRGIS INC
Entity Type:Organization
Organization Name:WAEL GIRGIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-239-6130
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:SUITE # 340
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5366
Mailing Address - Country:US
Mailing Address - Phone:618-239-6130
Mailing Address - Fax:618-277-0867
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:SUITE # 340
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5366
Practice Address - Country:US
Practice Address - Phone:618-239-6130
Practice Address - Fax:618-277-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL602570Medicare PIN
G00351Medicare UPIN