Provider Demographics
NPI:1770654725
Name:SABOOR, ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:SABOOR
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 1:19434 SOUTHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5160
Mailing Address - Country:US
Mailing Address - Phone:815-806-0735
Mailing Address - Fax:
Practice Address - Street 1:100 E JEFFERY ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-5018
Practice Address - Country:US
Practice Address - Phone:815-939-8011
Practice Address - Fax:815-939-8383
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061899A207R00000X
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL96461Medicare ID - Type UnspecifiedPROVIDER NUMBER
ILH46111Medicare UPIN
IL204077Medicare ID - Type UnspecifiedPROVIDER NUMBER