Provider Demographics
NPI:1740217686
Name:SALIBA, GEORGE J (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:SALIBA
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-502-4000
Practice Address - Fax:765-502-4709
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064809A207R00000X, 208M00000X
IL036108589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371391171002Medicaid
ILP00480255OtherRAILROAD MEDICARE PTAN
IL036108589OtherILLINOIS LICENSE
IL371391171006Medicaid
IL617396OtherHEALTHLINK #
INP01824550OtherRR PTAN
IL04800010OtherILLINOIS HEALTH CONNECT-NEWTON
IL336073507OtherILLINOIS CONTROLLED SUBSTANCE LICENSE
ILCG5365OtherRAILROAD MEDICARE GROUP
IL03300006OtherILLINOIS HEALTH CONNECT-EFFINGHAM
IN200902360Medicaid
IL036108589Medicaid
IL2523247OtherBC/BS#
337651OtherPERSONAL CARE
IL617396OtherHEALTHLINK
IL036108589Medicaid
IL617396OtherHEALTHLINK #
IN200902360Medicaid
IL371391171002Medicaid