Provider Demographics
NPI:1285164368
Name:AL ANBARI, RAGHDA (MD)
Entity type:Individual
Prefix:
First Name:RAGHDA
Middle Name:
Last Name:AL ANBARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29681 N WAUKEGAN RD APT 106
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-5481
Mailing Address - Country:US
Mailing Address - Phone:678-860-2648
Mailing Address - Fax:678-860-2648
Practice Address - Street 1:1500 OGLETHORPE AVE STE 500B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2184
Practice Address - Country:US
Practice Address - Phone:706-548-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125070982207R00000X
GA91026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine