Provider Demographics
NPI:1376097006
Name:ABDALLAH, ABDULLATIF
Entity Type:Individual
Prefix:
First Name:ABDULLATIF
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W LAKESIDE PL
Mailing Address - Street 2:APT # 1401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5175
Mailing Address - Country:US
Mailing Address - Phone:773-407-1799
Mailing Address - Fax:
Practice Address - Street 1:920 W LAKESIDE PL
Practice Address - Street 2:APT # 1401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5175
Practice Address - Country:US
Practice Address - Phone:773-407-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL81-3508998343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL81-3508998OtherNONE EMERGENCY TRANSPORTATION