Provider Demographics
NPI:1083043277
Name:ALDASOQI, IBRAHIM (APN)
Entity Type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:
Last Name:ALDASOQI
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3373
Mailing Address - Country:US
Mailing Address - Phone:773-319-2317
Mailing Address - Fax:
Practice Address - Street 1:606 POTTER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5337
Practice Address - Country:US
Practice Address - Phone:773-319-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010319363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner