Provider Demographics
NPI:1740284074
Name:ABDO, WA'EL M (MD)
Entity type:Individual
Prefix:DR
First Name:WA'EL
Middle Name:M
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 1:13400 S ROUTE 59 STE 116-306
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585
Mailing Address - Country:US
Mailing Address - Phone:866-653-6279
Mailing Address - Fax:815-717-7484
Practice Address - Street 1:3333 WARRENVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1999
Practice Address - Country:US
Practice Address - Phone:866-653-6279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116241 6Medicaid
ILK3941Medicare PIN
G66181Medicare UPIN
IL036116241 6Medicaid