Healthcare Provider Details

I. General information

NPI: 1144277534
Provider Name (Legal Business Name): BASSAM NMI AL-JOUNDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 N SEMINARY ST
GALESBURG IL
61401-1251
US

IV. Provider business mailing address

3375 N SEMINARY ST
GALESBURG IL
61401-1251
US

V. Phone/Fax

Practice location:
  • Phone: 309-343-7775
  • Fax: 309-343-2726
Mailing address:
  • Phone: 309-343-7775
  • Fax: 309-343-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036079696
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number036079696
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036079696
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: