MEDICARE: M. HASSAN DIAB, M.D., S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	3651347	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1155524	OTHER		MULTIPLANS NY
2	207R00000X	OTHER		TAXONOMY CODE INT MED
3	171903	OTHER		HEALTHLINK
4	0008100288	OTHER	IL	BLUE CROSS BLUE SHIELD
5	085055	OTHER		HEALTH ALLIANCE
6	15460	OTHER		MIDLANDS CHOICE
7	207RH0003X	OTHER		TAXONOMY CODE HEM/ONCOLOG
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	IL0101	OTHER		UNITED HEALTHCARE
10	98553	OTHER	IA	WELLMARK BC

General Provider Information

NPI Number	:	1780856187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. HASSAN DIAB, M.D., S.C.

Provider Business Mailing Address
First Line	:	2560 24TH ST
Second Line	:	SUITE 201
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5357
Country	:	US
Telephone Number	:	309-779-7491
Fax Number	:	309-779-3093

Provider Business Practice Location Address
First Line	:	2560 24TH ST
Second Line	:	SUITE 201
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5357
Country	:	US
Telephone Number	:	309-779-7491
Fax Number	:	309-779-3093

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MOHAMED HASSAN DIAB
Credential	:	M.D.
Telephone Number	:	309-779-7491

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	04/20/2008

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