Provider Demographics
NPI:1407585953
Name:KARIM, ABDUL QADIR
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:QADIR
Last Name:KARIM
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 1:422 GRAPE VINE TRL
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-6037
Mailing Address - Country:US
Mailing Address - Phone:630-864-1438
Mailing Address - Fax:
Practice Address - Street 1:1480 N ORCHARD RD STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-7940
Practice Address - Country:US
Practice Address - Phone:630-733-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1366678500Medicaid