Provider Demographics
NPI:1013345412
Name:ABDU-AS-SALAAM, TAQI QAYS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TAQI
Middle Name:QAYS
Last Name:ABDU-AS-SALAAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 W ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3240
Mailing Address - Country:US
Mailing Address - Phone:773-425-2344
Mailing Address - Fax:
Practice Address - Street 1:500 N NAPPANEE ST
Practice Address - Street 2:SUITE 11
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1503
Practice Address - Country:US
Practice Address - Phone:574-522-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28212423A367500000X
IL209013942367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered