Provider Demographics
NPI:1952491243
Name:SFEIR, HADY
Entity Type:Individual
Prefix:
First Name:HADY
Middle Name:
Last Name:SFEIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 GLEN PARK PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4688
Mailing Address - Country:US
Mailing Address - Phone:309-683-8383
Mailing Address - Fax:309-683-8386
Practice Address - Street 1:5105 GLEN PARK PL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4688
Practice Address - Country:US
Practice Address - Phone:309-683-8383
Practice Address - Fax:309-683-8386
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096259207R00000X
IL036-096259207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096259Medicaid
IL036096259Medicaid
ILK17777Medicare ID - Type UnspecifiedINDIVIDUAL #
IL207594Medicare ID - Type UnspecifiedGROUP #