PELE BOUTROUS DINA (NPI# 1275898116) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1275898116 |
Entity Type | Individual |
Full Name | PELE BOUTROUS DINA |
Credential | M.D |
Practice Address |
415 N 9th St # 4w16 Springfield IL 62702 |
Mailing Address |
Po Box 19676 Springfield IL 62794-9676 |
Practice Telephone | 2175458000 |
Practice Fax Number | 2177576844 |
Mailing Telephone | 2175458000 |
Mailing Fax Number | 2177576844 |
Enumeration Date | 2012-07-06 |
Last Update Date | 2018-05-16 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
036-138186 | IL | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | STATE LICENSE | 036-138186 | 01 |
Street Address |
415 N 9TH ST # 4W16 |
City | SPRINGFIELD |
State | IL |
Zip Code | 62702 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043776958 | Julie Michelle Livingston | Nurse Practitioner | 415 N 9th St # 4w16, Springfield, IL 62702-5303 | 2019-02-15 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
1588993430 | Lutheran Child and Family Services of Illinois | Foster Care Agency | 620 N. Walnut St., Springfield, IL 62702 | 2009-12-23 |
Find all providers in zip 62702 |
Taxonomy Code | 2080N0001X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Neonatal-Perinatal Medicine |
A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255623997 | Venkata Sasidhar Majjiga | Pediatrics | 301 N 8th Street, Siu School of Medicine, Pediatrics, Room 3a169, Springfield, IL 62794 | 2011-05-13 |
1831212976 | Douglas Terry Leonard | Pediatrics | 3355 River Bend Dr., Suite 220, Springfield, OR 97477-8800 | 2007-04-06 |
1992878169 | Michael Adrian Colasurdo | Pediatrics | 3355 Riverbend Dr Ste 220, Springfield, OR 97477-8800 | 2006-11-16 |
1699861740 | Saumitra Biswas | Pediatrics | 3801 S. National Avenue, 7th Floor, Springfield, MO 65807-5210 | 2006-10-05 |
1437116050 | Ozark Neonatal Associates, Inc. | Pediatrics | 1235 E Cherokee Street, Springfield, MO 65804-2203 | 2006-04-27 |
1841835816 | Stephanie Ann Barthelette | Pediatrics | 759 Chestnut St, Springfield, MA 01107-1619 | 2019-11-13 |
1275045171 | Kelsey Southard | Pediatrics | 3801 S National Ave, Springfield, MO 65807-5210 | 2017-11-01 |
1841607389 | Zaineh Alja'nini | Pediatrics | 1235 E Cherokee St, Springfield, MO 65804-2203 | 2014-07-16 |
1811242043 | Khushbu Shukla | Pediatrics | 3801 S National Ave, Springfield, MO 65807-5210 | 2012-07-13 |
1346507001 | Mohamed Farooq Ahamed | Pediatrics | 415 N 9th St, Suite 4w16, Springfield, IL 62702-5303 | 2012-04-19 |
Find all providers in SPRINGFIELD |
City | SPRINGFIELD |
Zip Code | 62702 |
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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.