Provider Demographics
NPI:1689759979
Name:TINWALLA, ABDI Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDI
Middle Name:Y
Last Name:TINWALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-4508
Mailing Address - Country:US
Mailing Address - Phone:630-469-9842
Mailing Address - Fax:
Practice Address - Street 1:RR1, BOX
Practice Address - Street 2:HORNEY ROAD AND COUNTY FARM ROAD
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681
Practice Address - Country:US
Practice Address - Phone:217-322-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361099692084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207288Medicare ID - Type Unspecified
ILH96308Medicare UPIN