Provider Demographics
NPI:1881603132
Name:ELSHERBINI, MEDHAT (MD)
Entity type:Individual
Prefix:
First Name:MEDHAT
Middle Name:
Last Name:ELSHERBINI
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 1:2401 W MAIN ST
Mailing Address - Street 2:VETERANS AFFAIR MEDICAL CENTER
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1188
Mailing Address - Country:US
Mailing Address - Phone:618-997-5311
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:VETERANS AFFAIR MEDICAL CENTER
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1188
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:801-352-9502
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116181207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00356270OtherRR MEDICARE
IL036116181OtherBCBS OF IL
ILK30352Medicare PIN
ILI6037Medicare UPIN