Provider Demographics
NPI:1457526576
Name:AL DADAH, ASHRAF SALAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:SALAH
Last Name:AL DADAH
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 1:3 SAINT ELIZABETH BLVD STE 2800
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1282
Mailing Address - Country:US
Mailing Address - Phone:618-233-6044
Mailing Address - Fax:618-233-5195
Practice Address - Street 1:3 SAINT ELIZABETH BLVD STE 2800
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-233-6044
Practice Address - Fax:618-233-5195
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122184207RC0000X, 207RI0011X
IL125052149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122184Medicaid
ILP01515327OtherRR MEDICARE
ILF400144883Medicare PIN