Provider Demographics
NPI:1295740678
Name:GHANAYEM, ANGIE ABDALLAH (OD)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:ABDALLAH
Last Name:GHANAYEM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7146 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1017
Mailing Address - Country:US
Mailing Address - Phone:773-775-3937
Mailing Address - Fax:773-775-3939
Practice Address - Street 1:7146 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1017
Practice Address - Country:US
Practice Address - Phone:773-775-3937
Practice Address - Fax:773-775-3939
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT-187-TA-721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist