Provider Demographics
NPI:1740217686
Name:SALIBA, GEORGE J (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:SALIBA
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1542 S BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2212
Practice Address - Country:US
Practice Address - Phone:765-301-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108589207R00000X
IN01064809A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01824550OtherRR PTAN
IL371391171002Medicaid
IL036108589OtherILLINOIS LICENSE
IL371391171006Medicaid
ILP00480255OtherRAILROAD MEDICARE PTAN
IL03300006OtherILLINOIS HEALTH CONNECT-EFFINGHAM
337651OtherPERSONAL CARE
IL617396OtherHEALTHLINK
IL617396OtherHEALTHLINK #
IL04800010OtherILLINOIS HEALTH CONNECT-NEWTON
IN200902360Medicaid
IL336073507OtherILLINOIS CONTROLLED SUBSTANCE LICENSE
ILCG5365OtherRAILROAD MEDICARE GROUP
IL2523247OtherBC/BS#
IL036108589Medicaid
IL036108589Medicaid
IL617396OtherHEALTHLINK #
IN200902360Medicaid
IL371391171002Medicaid