Individual
KHALED A DABASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 E GRANT ST, MACOMB, IL 61455-3368
(309) 836-5437
(309) 836-5417
Mailing address
515 E GRANT ST, MACOMB, IL 61455-3368
(309) 836-5437
(309) 836-5417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036089170
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010060
HEALTH ALLIANCE
IL
05
—
036089170
—
IL
01
—
5522926
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
06/16/2005
Last updated
07/15/2008
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