Healthcare Provider Details

I. General information

NPI: 1629899208
Provider Name (Legal Business Name): RUBA QASEM SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 FALCON RIDGE DR
BRIDGEVIEW IL
60455-2608
US

IV. Provider business mailing address

9101 FALCON RIDGE DR
BRIDGEVIEW IL
60455-2608
US

V. Phone/Fax

Practice location:
  • Phone: 872-210-7324
  • Fax:
Mailing address:
  • Phone: 872-210-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: