DR. YOUSEF SADEQ AL-SHRAIDEH (NPI# 1184989915) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184989915 |
| Entity Type | Individual |
| Full Name | DR. YOUSEF SADEQ AL-SHRAIDEH |
| Credential | MD |
| Practice Address |
1001 Main St Ste 400 Peoria IL 61606-2036 |
| Mailing Address |
Po Box 602658 Charlotte NC 28260-2658 |
| Practice Telephone | 3093080920 |
| Practice Fax Number | 3093080930 |
| Mailing Telephone | 3367162255 |
| Mailing Fax Number | 3367166637 |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2019-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 2012-0604 | NC | Allopathic & Osteopathic Physicians |
| Y | 208800000X | Urology | 036136798 | IL | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 2012-0904 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5921030 | 05 | |
| IL | 036136798 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| Medical Center Blvd, Winston Salem, NC 271570001 | 3367162255 | 3367166637 |
| 10 Orland Square Dr, Orland Park, IL 604623207 | 7084488913 |
| Street Address |
1001 MAIN ST STE 400 |
| City | PEORIA |
| State | IL |
| Zip Code | 61606-2036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871752501 | Wendy Olson Padilla | Urology | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2008-06-06 |
| 1417512328 | Nathan L. Bryant | Nurse Practitioner | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2019-05-06 |
| 1528562071 | Heidi N Cook | Nurse Practitioner | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2018-03-20 |
| 1215301221 | Gregory Garmon | Nurse Practitioner | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2015-11-16 |
| 1710380258 | Stephanie H Wieland | Nurse Practitioner | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2014-09-29 |
| 1023308483 | Jubilee Phan | Urology | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2011-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194292334 | Kelley Stork | Speech-Language Pathologist | 807 W Columbia Terrace, Peoria, IL 61606 | 2018-10-25 |
| 1689140519 | Emma Cristine Tully | Speech-Language Pathologist | 1619 W. Fredonia Ave, Peoria, IL 61606 | 2018-10-18 |
| 1316492432 | Jennifer Greenwood | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2016-08-18 |
| 1104944974 | Robert I Martin | Preventive Medicine | 1127 N North Street, Peoria, IL 61606 | 2007-03-27 |
| 1023062312 | Saint Francis Medical Center | Physical Medicine & Rehabilitation | 100 Ne Randoph Street, Peoria, IL 61606 | 2006-05-20 |
| 1174573307 | Cpo Services, Inc | Prosthetic/Orthotic Supplier | 741 West Main Street, Peoria, IL 61606 | 2006-05-10 |
| 1174025357 | Amy M Durst | Nurse Practitioner | 1001 Main St Ste 500a, Peoria, IL 61606 | 2018-03-05 |
| 1538471099 | Jacob Royle Hopping | Surgery | 1001 Main St Ste 300, Peoria, IL 61606 | 2010-07-12 |
| 1881906410 | Heather Jefford | Clinical Nurse Specialist | 1001 Main St, 3rd Floor, Peoria, IL 61606 | 2010-07-12 |
| 1306874128 | David L Crawford | Surgery | 1001 Main Street, Suite 300, Peoria, IL 61606 | 2006-06-29 |
| Find all providers in zip 61606 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871752501 | Wendy Olson Padilla | Urology | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2008-06-06 |
| 1356317416 | Daniel Mark Riesenberg | Urology | 30037 N Whipsaw Rd, 101, Peoria, AZ 85383-5195 | 2006-02-27 |
| 1932449691 | J&j Health Services LLC | Urology | 7309 N Knoxville Ave, Suite 200, Peoria, IL 61614-2085 | 2013-02-18 |
| 1023308483 | Jubilee Phan | Urology | 1001 Main St Ste 400, Peoria, IL 61606-2036 | 2011-04-19 |
| 1578870556 | Michael E Longevin Mdsc | Urology | 5401 N Knoxville Ave, Suite 112, Peoria, IL 61614-5098 | 2010-09-11 |
| 1548297252 | Churphena Reid | Urology | 1001 Main St, Suite 201, Peoria, IL 61606-1907 | 2006-06-27 |
| 1497795504 | Sheldon D Roberts | Urology | 13640 N Plaza Del Rio Blvd, Ste 310, Peoria, AZ 85381-4846 | 2006-06-07 |
| 1982659991 | Affiliated Urology Specialists, Ltd. | Urology | 200 E Pennsylvania Ave, Suite 201, Peoria, IL 61603-3089 | 2006-05-24 |
| 1538123468 | Peoria Urological Associates S.c | Urology | 7309 N Knoxville Ave, Peoria, IL 61614-2085 | 2006-04-17 |
| 1245294404 | Robert Stuart | Urology | 7309 N Knoxville Ave, Peoria, IL 61614-2085 | 2006-04-14 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.