Provider Demographics
NPI:1992847388
Name:HAJJO-RIFAI, SALEH (MD)
Entity Type:Individual
Prefix:
First Name:SALEH
Middle Name:
Last Name:HAJJO-RIFAI
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 1:2677 ROUTE 34
Mailing Address - Street 2:SUITE C
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8633
Mailing Address - Country:US
Mailing Address - Phone:630-551-2222
Mailing Address - Fax:630-551-1510
Practice Address - Street 1:2677 ROUTE 34
Practice Address - Street 2:SUITE C
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8633
Practice Address - Country:US
Practice Address - Phone:630-551-2222
Practice Address - Fax:630-551-1510
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087128207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK21412Medicare PIN