Provider Demographics
NPI:1265418982
Name:RAHEB, ADEL SAMY (MD)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:SAMY
Last Name:RAHEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ADEL
Other - Middle Name:SAMY
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3981
Mailing Address - Country:US
Mailing Address - Phone:217-366-1255
Mailing Address - Fax:
Practice Address - Street 1:101 W UNIVERSITY AVE STE 303
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3981
Practice Address - Country:US
Practice Address - Phone:217-366-1255
Practice Address - Fax:217-429-0108
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110172207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110172Medicaid
IL05832038OtherBLUE CROSS/BLUE SHIELD
ILDE3439OtherRAILROAD MEDICARE GROUP PIN
IL634112OtherHEALTHLINK
ILP00286821OtherRAILROAD MEDICARE PIN
IL634112OtherHEALTHLINK
ILH99460Medicare UPIN