Basic Information
| Provider Information | |||||||||
| NPI: | 1821526492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDOU | ||||||||
| FirstName: | AHMED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 W 156TH ST STE 108 | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604264262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083880499 | ||||||||
| FaxNumber: | 7083880283 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 W 156TH ST STE 108 | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604264262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083880499 | ||||||||
| FaxNumber: | 7083880283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | 036.152294 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.