Provider Demographics
NPI:1710037742
Name:ABDULLA, RAID (MD)
Entity Type:Individual
Prefix:
First Name:RAID
Middle Name:
Last Name:ABDULLA
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 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:770 JONES
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-6800
Mailing Address - Fax:312-942-6801
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:770 JONES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-6800
Practice Address - Fax:312-942-6801
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-085177208000000X
IL0360851772080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085177Medicaid
L94201Medicare ID - Type Unspecified