Provider Demographics
NPI:1194836924
Name:SABBAGH, HAISSAM (MD)
Entity type:Individual
Prefix:
First Name:HAISSAM
Middle Name:
Last Name:SABBAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W HILLGROVE AVE UNIT 871
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-1035
Mailing Address - Country:US
Mailing Address - Phone:708-691-8981
Mailing Address - Fax:630-850-7018
Practice Address - Street 1:121 W HILLGROVE AVE UNIT 871
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-1035
Practice Address - Country:US
Practice Address - Phone:708-691-8981
Practice Address - Fax:630-850-7018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36047078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL021607135OtherBCBS
IL036047078Medicaid
IL493750Medicare ID - Type Unspecified
IL036047078Medicaid