Individual
DR. FADI M MUSTAPHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 E 1ST ST, DIXON, IL 61021
(815) 285-5843
(815) 285-5846
Mailing address
215 E 1ST ST, DIXON, IL 61021-3175
(815) 285-5843
(815) 285-5846
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036-115681
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-115681
ILLINOIS MEDICAL LICENSE
IL
01
—
K28334
MEDICARE
IL
Enumeration date
06/18/2006
Last updated
08/22/2018
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