Provider Demographics
NPI:1891727236
Name:ABDUR-RAHMAN, IDRIES (MD)
Entity Type:Individual
Prefix:
First Name:IDRIES
Middle Name:
Last Name:ABDUR-RAHMAN
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 1:1300 STARFIRE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1624
Mailing Address - Country:US
Mailing Address - Phone:815-434-2229
Mailing Address - Fax:815-434-4229
Practice Address - Street 1:1300 STARFIRE DR
Practice Address - Street 2:SUITE B
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1624
Practice Address - Country:US
Practice Address - Phone:815-434-2229
Practice Address - Fax:815-434-4229
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114960207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology