Provider Demographics
NPI:1295868032
Name:HERAND ABCARIAN MD SC
Entity Type:Organization
Organization Name:HERAND ABCARIAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERAND
Authorized Official - Middle Name:
Authorized Official - Last Name:ABCARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-450-5075
Mailing Address - Street 1:675 W NORTH AVENUE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-450-5075
Mailing Address - Fax:708-681-7694
Practice Address - Street 1:675 W NORTH AVENUE
Practice Address - Street 2:SUITE 406
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-450-5075
Practice Address - Fax:708-681-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31623050OtherBLUE CROSS BLUE SHIELD
IL31623050OtherBLUE CROSS BLUE SHIELD
C41575Medicare UPIN