Provider Demographics
NPI:1356344287
Name:HARB, GHASOUB (MD)
Entity type:Individual
Prefix:DR
First Name:GHASOUB
Middle Name:
Last Name:HARB
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 1:3319 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-359-1641
Mailing Address - Fax:563-359-4634
Practice Address - Street 1:3319 SPRING STREET
Practice Address - Street 2:UROLOGICAL ASSC PC
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-359-1641
Practice Address - Fax:563-359-4634
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093919208800000X
IA31158208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL340012664OtherMEDICARE RAILROAD
IL036093919Medicaid
IA0139048Medicaid
IA340011843OtherMEDICARE RAILROAD
IAG24770Medicare UPIN
IA53769Medicare ID - Type Unspecified
IL036093919Medicaid
IL0184500003Medicare NSC
IL336552Medicare PIN
IA07364Medicare PIN
IA340011843OtherMEDICARE RAILROAD