Provider Demographics
NPI:1497135750
Name:ABRAHAM, HRUDYA (MD)
Entity Type:Individual
Prefix:DR
First Name:HRUDYA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-5025
Mailing Address - Country:US
Mailing Address - Phone:309-671-8270
Mailing Address - Fax:309-672-3171
Practice Address - Street 1:900 MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5025
Practice Address - Country:US
Practice Address - Phone:309-671-8270
Practice Address - Fax:309-672-3171
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.132982390200000X
IL036150430207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program