Provider Demographics
NPI:1982891826
Name:ELHAG, WAHIBA M (MD)
Entity Type:Individual
Prefix:
First Name:WAHIBA
Middle Name:M
Last Name:ELHAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1057
Mailing Address - Country:US
Mailing Address - Phone:708-383-5809
Mailing Address - Fax:708-383-5153
Practice Address - Street 1:6645 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1057
Practice Address - Country:US
Practice Address - Phone:708-383-5809
Practice Address - Fax:708-383-5153
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117758207R00000X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDG5947OtherRAILROAD MEDICARE GROUP
ILP00443434OtherRAILROAD MEDICARE INDIVID
ILDG5947OtherRAILROAD MEDICARE GROUP
ILK46300Medicare PIN