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General NPI Number Information
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NPI Number | 1972937480
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Entity Type | Organization
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Legal Business Name | SABEEHA HAQUE ALI MD LLC
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 102 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-8513
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Country | US
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Telephone | 217-442-5863
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Fax | 217-442-5040
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Provider Business Mailing Address
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Address Line | 102 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-8513
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Country | US
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Telephone | 217-442-5863
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Fax | 217-442-5040
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | SABEEHA HAQUE
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Credential | M.D.
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Telephone | 312-545-9727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 036109029
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License Number State | IL
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