Provider Demographics
NPI:1821227976
Name:ROYEEN, ABDUL WAHID (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:WAHID
Last Name:ROYEEN
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 1:331 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:IL
Mailing Address - Zip Code:62691-1571
Mailing Address - Country:US
Mailing Address - Phone:217-452-3057
Mailing Address - Fax:217-452-7245
Practice Address - Street 1:331 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:IL
Practice Address - Zip Code:62691
Practice Address - Country:US
Practice Address - Phone:217-452-3057
Practice Address - Fax:217-452-7245
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine