Provider Demographics
NPI:1811978448
Name:HOSSEINIAN, ABDOL (MD)
Entity type:Individual
Prefix:DR
First Name:ABDOL
Middle Name:
Last Name:HOSSEINIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4250 N MARINE DR
Mailing Address - Street 2:SUITE 236
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1744
Mailing Address - Country:US
Mailing Address - Phone:773-404-0160
Mailing Address - Fax:773-404-9876
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-525-4500
Practice Address - Fax:773-525-3416
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036044385207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044385Medicaid
IL036044385Medicaid
IL335110Medicare PIN