Provider Demographics
NPI:1790098804
Name:ADIB, KEENAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEENAN
Middle Name:
Last Name:ADIB
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 1:908 N ELM ST STE 404
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3638
Mailing Address - Country:US
Mailing Address - Phone:630-789-3422
Mailing Address - Fax:630-789-9003
Practice Address - Street 1:908 N ELM ST STE 404
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3638
Practice Address - Country:US
Practice Address - Phone:630-789-3422
Practice Address - Fax:630-789-9003
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460526207RC0000X
NY284397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease