Provider Demographics
NPI:1750015624
Name:KAMAL, ABIOLA IDRIS
Entity type:Individual
Prefix:
First Name:ABIOLA
Middle Name:IDRIS
Last Name:KAMAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 E 90TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7936
Mailing Address - Country:US
Mailing Address - Phone:312-804-1847
Mailing Address - Fax:
Practice Address - Street 1:1136 E 90TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7936
Practice Address - Country:US
Practice Address - Phone:312-804-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)