Provider Demographics
NPI:1578325908
Name:ABDIOW, IBRAHIM M
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:M
Last Name:ABDIOW
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 1:6426 N RIDGE BLVD APT 3M
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4864
Mailing Address - Country:US
Mailing Address - Phone:312-868-4900
Mailing Address - Fax:
Practice Address - Street 1:6426 N RIDGE BLVD APT 3M
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4864
Practice Address - Country:US
Practice Address - Phone:312-868-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILDH58490343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)