Individual
DR. FATHY Z. BASILIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 WINDSOR RD, CHAMPAIGN, IL 61822-6217
(217) 366-1257
Mailing address
1801 WINDSOR RD, CHAMPAIGN, IL 61822-6217
(217) 366-1257
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-073898
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073898 3
—
IL
01
—
279500
MEDICARE GROUP
IL
Enumeration date
07/31/2006
Last updated
06/17/2008
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