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Contact Information

FADI M MUSTAPHA, MD
215 E 1ST ST
DIXON, IL61021
 Phone: 815-285-5843
 Fax: 815-285-5846
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
Indicates primary specialty

NPI Profile & details for FADI M MUSTAPHA · (Male)

NPI # 1508801986
Status Active
Credentials MD
Entity Individual
Enumeration date 06/18/2006
Last updated 08/22/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036-115681
  • IL Other 036-115681 ILLINOIS MEDICAL LICENSE
  • IL Other K28334 MEDICARE
Hospital affiliation(s)
  • KATHERINE SHAW BETHEA HOSPITAL - (Acute Care)
    403 E 1ST ST
    DIXON, IL 61021
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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