Provider Demographics
NPI:1790992675
Name:ABU AL RUB, FADEE (MD)
Entity Type:Individual
Prefix:DR
First Name:FADEE
Middle Name:
Last Name:ABU AL RUB
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:CENTER FOR SPECIALIZED MEDICINE
Mailing Address - Street 2:1225 S GRAND BLVD.
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-257-3760
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR SPECIALIZED MEDICINE
Practice Address - Street 2:1225 S GRAND BLVD.
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-257-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139742208M00000X
MO2013042711208M00000X, 207RN0300X
CAC163034207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist