Healthcare Provider Details

I. General information

NPI: 1205418886
Provider Name (Legal Business Name): RIDA MOHAMMAD GAREEB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIDA MOOSA MD

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 MAIN ST STE C
PEORIA IL
61602-1080
US

IV. Provider business mailing address

1600 W BLUE SAGE DR APT 3312
PEORIA IL
61615-7228
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-4986
  • Fax:
Mailing address:
  • Phone: 346-465-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036166614
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: