Healthcare Provider Details

I. General information

NPI: 1700579653
Provider Name (Legal Business Name): OBADA DAABOUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W CARPENTER ST # A
SPRINGFIELD IL
62702-4901
US

IV. Provider business mailing address

315 W CARPENTER ST # A
SPRINGFIELD IL
62702-4901
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-5459
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036179938
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036179938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: