Ibrahim Marouf Yasin Al Shyyab, MD
Individual provider Active NPI Pediatrics Physician · Springfield, IL
NPI 1689565327 · NPPES record last updated Jul 11, 2025
Key facts
- NPI
- 1689565327
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 125085559 (IL)
- Practice address
- 400 N 9TH St # 4a
Springfield, IL 62702-5310 - Phone
- (217) 545-8000
- NPI assigned
- Jul 11, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250818000525 | IL | Order and Referring Only - Pediatric Medicine |
1850890849 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125085559 | IL | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 125085559 | IL | Yes |
Addresses
Primary practice location
400 N 9TH St # 4a
Springfield, IL 62702-5310
Mailing address
400 N 9TH St # 4a
Springfield, IL 62702-5310
Other providers in Springfield, IL
- Gregory Darrell Akers
- Shefta Ahmed Akhunji
- Taiwo D Akinsoji
- Suzan Al Gharaibeh
- Hayder Al Khafaji
- Omar Al Tamimi
- Raad Al Tamimi
- Ahmad Al Turk
- Rami Al-Ayyubi
- Haitham Al-Dhmour
All providers in Springfield, IL · Pediatrics Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.