Individual
DR. WAEL MOHAMMAD OTAIBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1770 E LAKE SHORE DR STE 105, DECATUR, IL 62521-3800
(217) 329-1000
(217) 329-1055
Mailing address
3051 HOLLIS DR FL 2, SPRINGFIELD, IL 62704-7452
(217) 523-5432
(217) 492-9643
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036150787
IL
208600000X
Surgery Physician
254927
NY
208600000X
Surgery Physician
34.011232
OH
208600000X
Surgery Physician
5101015634
MI
Other
Enumeration date
04/02/2007
Last updated
11/15/2019
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