Provider Demographics
NPI:1023124310
Name:GHALY, BASSEM (MD)
Entity type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:GHALY
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:DEPARTMENT 4330
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4330
Mailing Address - Country:US
Mailing Address - Phone:847-495-1603
Mailing Address - Fax:847-537-4866
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA, ABMC
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3597
Practice Address - Fax:847-981-5589
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108198207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001620300OtherBLUECROSS BLUESHILD OF IL
IL036108198 1Medicaid
IL364054341OtherCOMMERCIAL INS.GROUP#
ILI04962Medicare UPIN
IL036108198 1Medicaid