Provider Demographics
NPI:1184849747
Name:AHDAB, TAREK MOHAMAD (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:MOHAMAD
Last Name:AHDAB
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:DR
Other - First Name:MOHAMAD
Other - Middle Name:TAREK
Other - Last Name:ALAHDAB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12400 S HARLEM AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1477
Mailing Address - Country:US
Mailing Address - Phone:708-923-7650
Mailing Address - Fax:708-923-7655
Practice Address - Street 1:12400 S HARLEM AVE STE 112
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1477
Practice Address - Country:US
Practice Address - Phone:708-923-7650
Practice Address - Fax:708-923-7655
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105726207RC0000X, 2085R0204X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL92325OtherPROVIDER NUMBER
ILIL1600002Medicare PIN
ILIL1648002Medicare PIN
ILL92325OtherPROVIDER NUMBER
ILH65174Medicare UPIN
ILIL7368001Medicare UPIN