Provider Demographics
NPI:1699720896
Name:ALMUSADDY, MOUSAB (MD)
Entity type:Individual
Prefix:
First Name:MOUSAB
Middle Name:
Last Name:ALMUSADDY
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 1:1603 WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3274
Mailing Address - Country:US
Mailing Address - Phone:630-887-1262
Mailing Address - Fax:630-887-1720
Practice Address - Street 1:1600 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1902
Practice Address - Country:US
Practice Address - Phone:815-729-0111
Practice Address - Fax:815-729-3399
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102603207RP1001X, 207RC0200X
KY37863207RP1001X, 207R00000X
IN01061060A207R00000X, 207RC0200X, 207RP1001X
TN39580207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3326345OtherMEDICAID
KY64066772Medicaid
IL036102603OtherMEDICAID
TN3326345OtherMEDICAID
IL036102603OtherMEDICAID
KY64066772Medicaid