Healthcare Provider Details

I. General information

NPI: 1417033705
Provider Name (Legal Business Name): SABEEHA HAQUE ALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SABEEHA HAQUE MD

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N LOGAN AVE
DANVILLE IL
61832-8513
US

IV. Provider business mailing address

102 N LOGAN AVE
DANVILLE IL
61832-8513
US

V. Phone/Fax

Practice location:
  • Phone: 217-442-5863
  • Fax: 217-442-5040
Mailing address:
  • Phone: 217-442-5863
  • Fax: 217-442-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036109029
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: