Provider Demographics
NPI:1417385238
Name:ABDIEL MEDICAL SPECIALTY LLC
Entity Type:Organization
Organization Name:ABDIEL MEDICAL SPECIALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOILANEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-566-3129
Mailing Address - Street 1:209 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2735
Mailing Address - Country:US
Mailing Address - Phone:847-566-3129
Mailing Address - Fax:847-566-1829
Practice Address - Street 1:209 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2735
Practice Address - Country:US
Practice Address - Phone:847-566-3129
Practice Address - Fax:847-566-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty