Individual
DR. REFAT DAHERDIAB KHADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0449
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036099655
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
NGS GROUP PTAN
IL
Enumeration date
08/17/2005
Last updated
09/24/2021
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