Provider Demographics
NPI:1689662942
Name:AGULNEK, ABBY (DO)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:AGULNEK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E. HURON
Mailing Address - Street 2:FEINBERG 16-738
Mailing Address - City:CHICAGO
Mailing Address - State:ILLINOIS
Mailing Address - Zip Code:60611
Mailing Address - Country:UM
Mailing Address - Phone:312-926-5924
Mailing Address - Fax:312-926-6134
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-695-9797
Practice Address - Fax:312-926-6134
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110800207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I15951Medicare UPIN