Healthcare Provider Details

I. General information

NPI: 1508701996
Provider Name (Legal Business Name): SAMA ALHALABI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 N ILLINOIS ST
SWANSEA IL
62226-1919
US

IV. Provider business mailing address

4243 BURNETT WALK
SAINT LOUIS MO
63125-2311
US

V. Phone/Fax

Practice location:
  • Phone: 618-277-1130
  • Fax:
Mailing address:
  • Phone: 314-585-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: