Provider Demographics
NPI:1356415350
Name:AMINE, ABDUL (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:AMINE
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 1:6815 WEST 95TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-7000
Mailing Address - Country:US
Mailing Address - Phone:708-430-3350
Mailing Address - Fax:708-430-3551
Practice Address - Street 1:6815 WEST 95TH STREET
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-7000
Practice Address - Country:US
Practice Address - Phone:708-430-3350
Practice Address - Fax:708-430-3551
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
21607606OtherBC BS
D13244Medicare UPIN
21607606OtherBC BS