Provider Demographics
NPI:1487705240
Name:ABBASI, KHALDA (MD)
Entity type:Individual
Prefix:MRS
First Name:KHALDA
Middle Name:
Last Name:ABBASI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9790
Mailing Address - Country:US
Mailing Address - Phone:630-416-2300
Mailing Address - Fax:
Practice Address - Street 1:636 RAYMOND DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9789
Practice Address - Country:US
Practice Address - Phone:630-416-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16455Medicare UPIN