Provider Demographics
NPI:1891705182
Name:QADIR, ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:QADIR
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 1:1414 W ILLINOIS AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1920
Mailing Address - Country:US
Mailing Address - Phone:630-301-7366
Mailing Address - Fax:630-301-7369
Practice Address - Street 1:1414 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1920
Practice Address - Country:US
Practice Address - Phone:630-301-7366
Practice Address - Fax:630-301-7369
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG59275Medicare UPIN