Provider Demographics
NPI:1083880348
Name:ABBASI M.D.S.C.
Entity Type:Organization
Organization Name:ABBASI M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-206-1090
Mailing Address - Street 1:17680 KEDZIE AVE
Mailing Address - Street 2:206
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2043
Mailing Address - Country:US
Mailing Address - Phone:708-206-1090
Mailing Address - Fax:708-310-4327
Practice Address - Street 1:10639 GREAT EGRET DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8490
Practice Address - Country:US
Practice Address - Phone:708-460-9192
Practice Address - Fax:708-310-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068401207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068401Medicaid
IL036068401Medicaid