Individual
DR. BASSIL KHERALLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-4000
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-4000
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036165319
IL
390200000X
Student in an Organized Health Care Education/Training Program
90200000X
—
Other
Enumeration date
03/25/2019
Last updated
11/19/2024
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