Provider Demographics
NPI:1952359242
Name:DIBS, SAMER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:DIBS
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 257610
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-8633
Mailing Address - Country:US
Mailing Address - Phone:773-728-0000
Mailing Address - Fax:773-728-0002
Practice Address - Street 1:2222 W DIVISION ST STE 330
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2995
Practice Address - Country:US
Practice Address - Phone:773-728-0000
Practice Address - Fax:773-728-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36102728207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102728Medicaid
ILF76424Medicare UPIN