Provider Demographics
NPI:1255495701
Name:ABBASI, TAHIR A (MD)
Entity type:Individual
Prefix:
First Name:TAHIR
Middle Name:A
Last Name:ABBASI
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 1:17680 KEDZIE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2043
Mailing Address - Country:US
Mailing Address - Phone:708-206-1090
Mailing Address - Fax:708-460-9192
Practice Address - Street 1:17680 KEDZIE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2043
Practice Address - Country:US
Practice Address - Phone:708-206-1090
Practice Address - Fax:708-460-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068401207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN364063266OtherBLUE CROSS BLUE SHIELD
INP00369878OtherRAIL ROAD MEDICARE
IL036068401Medicaid
IL060029163OtherRAIL ROAD MEDICARE
IL0001608454OtherBLUE CROSS/ BLUE SHIELD
IL767893Medicare PIN
IN364063266OtherBLUE CROSS BLUE SHIELD
IN709950Medicare PIN
ILC48869Medicare UPIN