Provider Demographics
NPI:1184837155
Name:ABDALA, AHUAD L (MD)
Entity Type:Individual
Prefix:DR
First Name:AHUAD
Middle Name:L
Last Name:ABDALA
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 1:6911 CONCORD LANE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:773-376-4040
Mailing Address - Fax:773-890-1203
Practice Address - Street 1:1824 W. 47TH ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609
Practice Address - Country:US
Practice Address - Phone:773-376-4040
Practice Address - Fax:773-890-1203
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056658208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice