Basic Information
| Provider Information | |||||||||
| NPI: | 1487941969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABBASI | ||||||||
| FirstName: | WALEED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 N ROCKTON AVE | ||||||||
| Address2: | PEDIATRIC HOSPITALIST SVCS. | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611033655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159715000 | ||||||||
| FaxNumber: | 8159716326 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 N ROCKTON AVE | ||||||||
| Address2: | PEDIATRIC HOSPITALIST SVCS. | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611033655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159715000 | ||||||||
| FaxNumber: | 8159716326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 10/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT200569 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 036135756 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.