Provider Demographics
NPI:1255375887
Name:BARAKAT, ROUBA (MD)
Entity type:Individual
Prefix:DR
First Name:ROUBA
Middle Name:
Last Name:BARAKAT
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 1:7451 WOODWARD AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2665
Mailing Address - Country:US
Mailing Address - Phone:630-724-0357
Mailing Address - Fax:
Practice Address - Street 1:7451 WOODWARD AVE
Practice Address - Street 2:SUITE108
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2665
Practice Address - Country:US
Practice Address - Phone:630-724-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090768Medicaid
CAQHOther10573379
ILILLINOIS MEDICAIDOther036090768
ILILLINOIS MEDICAIDOther036090768