Provider Demographics
NPI:1730108804
Name:AL-SHARIF, NABIL (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:AL-SHARIF
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:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:618-529-0586
Practice Address - Street 1:409 W OAK ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1414
Practice Address - Country:US
Practice Address - Phone:618-529-4455
Practice Address - Fax:618-351-1287
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087263207Q00000X
IL036.087263207RA0001X, 207RA0002X
IL036-087263207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087263Medicaid
ILP00835872OtherRAILROAD
IL214881Medicare Oscar/Certification
IL517330008Medicare PIN
ILP00835872OtherRAILROAD
ILK33091Medicare PIN
IL214881181Medicare PIN