MEDICARE: DR. GHASOUB HARB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	036093919	IL
2	208800000X	Urology Physician	31158	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	340012664	OTHER	IL	MEDICARE RAILROAD
4	340011843	OTHER	IA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356344287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHASOUB HARB MD

Provider Business Mailing Address
First Line	:	3319 SPRING STREET
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807
Country	:	US
Telephone Number	:	563-359-1641
Fax Number	:	563-359-4634

Provider Business Practice Location Address
First Line	:	3319 SPRING STREET
Second Line	:	UROLOGICAL ASSC PC
City	:	DAVENPORT
State	:	IA
Zip	:	52807
Country	:	US
Telephone Number	:	563-359-1641
Fax Number	:	563-359-4634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/29/2021

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Directions to “ DR. GHASOUB HARB MD” Practice Location

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