Provider Demographics
NPI:1881825594
Name:ABU-EL-HAIJA, BASIL (MD)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:
Last Name:ABU-EL-HAIJA
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 1:619 E MASON ST STE 4P57
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1034
Mailing Address - Country:US
Mailing Address - Phone:217-788-0706
Mailing Address - Fax:217-525-2535
Practice Address - Street 1:619 E MASON ST STE 4P57
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1034
Practice Address - Country:US
Practice Address - Phone:217-788-0706
Practice Address - Fax:217-525-2535
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2023-11-13
Deactivation Date:2020-09-21
Deactivation Code:
Reactivation Date:2020-10-23
Provider Licenses
StateLicense IDTaxonomies
IL036167582207RC0001X
KS9407281207R00000X
MI4301116360207RC0001X
KY54437207RC0001X
IN01084715A207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine