Provider Demographics
NPI:1255338588
Name:DIAB, M HASSAN (MD)
Entity type:Individual
Prefix:MR
First Name:M
Middle Name:HASSAN
Last Name:DIAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3651347207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08100288OtherBLUE CROSS BLUE SHIELD
IL08100288OtherBLUE CROSS BLUE SHIELD
IL213730Medicare ID - Type Unspecified