Healthcare Provider Details

I. General information

NPI: 1184018178
Provider Name (Legal Business Name): NABIL DAVID BADDOUR D.O., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROXBURY RD
ROCKFORD IL
61107-5078
US

IV. Provider business mailing address

401 ROXBURY RD
ROCKFORD IL
61107-5078
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-7340
  • Fax: 815-397-7388
Mailing address:
  • Phone: 815-397-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036156514
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: