Organization
CARLE CLINIC ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZUHEIR KASSABO MD (HOSPITALIST)
(217) 355-7951
Entity
Organization
Contact information
Practice address
701 KREBS DR, CHAMPAIGN, IL 61822
(217) 355-7951
Mailing address
701 KREBS DR, CHAMPAIGN, IL 61822
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-115508
IL
282N00000X
General Acute Care Hospital
Primary
036-115508
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115508
—
IL
01
—
833120
MEDICARE GROUP #
—
01
—
CA2264
RR GROUP #
IL
01
—
P00729199
RR MEDICARE INDIVIDUAL #
IL
Enumeration date
03/06/2007
Last updated
08/31/2009
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