Healthcare Provider Details

I. General information

NPI: 1043537871
Provider Name (Legal Business Name): MOHAMED RAFA LABEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N RUTLEDGE ST
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

PO BOX 19627
SPRINGFIELD IL
62794-9627
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 217-545-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036144636
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036144636
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036144636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: