Individual
HAITHAM HASSANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBCH
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 351-4878
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
036146447
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.146447
ILLINOIS PHYSICIAN LICENSE
IL
Enumeration date
05/12/2014
Last updated
10/30/2020
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