Provider Demographics
NPI:1124233291
Name:CHAIBAN, JOUMANA TANNOUS (MD)
Entity type:Individual
Prefix:DR
First Name:JOUMANA
Middle Name:TANNOUS
Last Name:CHAIBAN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8127
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-3000
Mailing Address - Fax:314-747-7065
Practice Address - Street 1:11600 S KEDZIE AVE STE D
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-6308
Practice Address - Country:US
Practice Address - Phone:708-684-6867
Practice Address - Fax:708-684-6869
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015013437207RE0101X
IL036-133347207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3110805Medicaid
OH4306901Medicare PIN