Provider Demographics
NPI:1346208956
Name:ABBOUD, MAHA (MD FACE)
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:
Last Name:ABBOUD
Suffix:
Gender:F
Credentials:MD FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-345-2211
Mailing Address - Fax:708-345-2224
Practice Address - Street 1:1835 N 19TH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2040
Practice Address - Country:US
Practice Address - Phone:708-345-2211
Practice Address - Fax:708-345-2224
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086473207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086473Medicaid
G35039Medicare UPIN
IL036086473Medicaid
IL212089Medicare ID - Type Unspecified