Provider Demographics
NPI:1760596357
Name:SHIBLI RAHHAL, AMAL ALI (MD)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:ALI
Last Name:SHIBLI RAHHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMAL
Other - Middle Name:ALI
Other - Last Name:SHIBLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-338-0581
Mailing Address - Fax:319-339-7025
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:319-339-7025
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36739207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0729418Medicaid
IA27801OtherWELLMARK BCBS
IA0729418Medicaid
IAI18352Medicare PIN
I61312Medicare UPIN