1245325018 NPI number — WOROOD ABBOUD M.D.

Table of content: WOROOD ABBOUD M.D. (NPI 1245325018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245325018 NPI number — WOROOD ABBOUD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBOUD
Provider First Name:
WOROOD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245325018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 713260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-469-9200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2614 W. JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-725-1355
Provider Business Practice Location Address Fax Number:
815-725-9857
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  036-103016 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K30830 . This is a "MEDICARE INDIV ID# FOR GROUP 336140" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: K30832 . This is a "MEDICARE INDIV ID# FOR GROUP 208256" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036103016 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: K30831 . This is a "MEDICARE ID# FOR GROUP 205474" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00371773 . This is a "MEDICARE RR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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