Provider Demographics
NPI:1841556735
Name:ABBAN, CYNTHIA YVONNE (MD/PHD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YVONNE
Last Name:ABBAN
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1551
Mailing Address - Country:US
Mailing Address - Phone:847-245-8448
Mailing Address - Fax:
Practice Address - Street 1:7505 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1551
Practice Address - Country:US
Practice Address - Phone:847-245-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139379207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100059191Medicaid