Provider Demographics
NPI:1962497032
Name:ABDO, TOUFIC (MD)
Entity Type:Individual
Prefix:
First Name:TOUFIC
Middle Name:
Last Name:ABDO
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-3490
Mailing Address - Fax:217-383-3439
Practice Address - Street 1:1813 W. KIRBY AVENUE
Practice Address - Street 2:ENDOCRINOLOGY
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821
Practice Address - Country:US
Practice Address - Phone:217-383-3490
Practice Address - Fax:217-383-3439
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124068207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265764300Medicaid
IL6447860018Medicare NSC
FL265764300Medicaid
FL62839ZMedicare ID - Type Unspecified
ILIL3270212Medicare PIN