Provider Demographics
NPI:1659529196
Name:SHAABAN, HADI FAROUK (DO)
Entity type:Individual
Prefix:
First Name:HADI
Middle Name:FAROUK
Last Name:SHAABAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8409
Mailing Address - Country:US
Mailing Address - Phone:815-759-4530
Mailing Address - Fax:815-759-8053
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-759-4530
Practice Address - Fax:815-759-8053
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63992-212086S0127X, 2086S0127X
IL0361232322086S0102X
IN02004925A208600000X
GA827812086S0102X
IL036-1232322086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1659529126Medicaid
WI1659529196OtherBCBSWI
WISHAABHADOtherMERCYCARE INSURANCE
WIK400240448-000054176Medicare PIN