Provider Demographics
NPI:1780856187
Name:M. HASSAN DIAB, M.D., S.C.
Entity Type:Organization
Organization Name:M. HASSAN DIAB, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:DIAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-779-7491
Mailing Address - Street 1:2560 24TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5357
Mailing Address - Country:US
Mailing Address - Phone:309-779-7491
Mailing Address - Fax:309-779-3093
Practice Address - Street 1:2560 24TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5357
Practice Address - Country:US
Practice Address - Phone:309-779-7491
Practice Address - Fax:309-779-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3651347207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1155524OtherMULTIPLANS NY
207R00000XOtherTAXONOMY CODE INT MED
171903OtherHEALTHLINK
IL0008100288OtherBLUE CROSS BLUE SHIELD
085055OtherHEALTH ALLIANCE
15460OtherMIDLANDS CHOICE
207RH0003XOtherTAXONOMY CODE HEM/ONCOLOG
IA0984328OtherIOWA MEDICAID
IL0101OtherUNITED HEALTHCARE
IA98553OtherWELLMARK BC
171903OtherHEALTHLINK
171903OtherHEALTHLINK