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General NPI Number Information
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NPI Number | 1831191584
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Entity Type | Individual
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Provider Name | ABDULLAH ALTAYEH M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 2350 N ROCKTON AVE ROCKFORD HEALTH PHYSICIANS
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City | ROCKFORD
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State | IL
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Zip | 61103-3619
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Country | US
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Telephone | 815-971-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 N ROCKTON AVE ROCKFORD HEALTH PHYSICIANS
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City | ROCKFORD
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State | IL
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Zip | 61103-3619
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Country | US
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Telephone | 815-971-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-112478
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 52143
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036112478
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036112478
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 104298
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License Number State | MN
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22594
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License Number State | WV
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