Provider Demographics
NPI:1952897134
Name:FEDT-ABDO, ALEESA N (MD)
Entity Type:Individual
Prefix:
First Name:ALEESA
Middle Name:N
Last Name:FEDT-ABDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEESA
Other - Middle Name:
Other - Last Name:FEDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2650 RIDGE AVE # 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-1027
Mailing Address - Fax:847-733-5108
Practice Address - Street 1:2650 RIDGE AVE # 1223
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1700
Practice Address - Country:US
Practice Address - Phone:847-570-1027
Practice Address - Fax:847-733-5108
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036165670208000000X, 208M00000X
WI7209851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics