Provider Demographics
NPI:1487941969
Name:ABBASI, WALEED (MD)
Entity type:Individual
Prefix:
First Name:WALEED
Middle Name:
Last Name:ABBASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N ROCKTON AVE
Mailing Address - Street 2:PEDIATRIC HOSPITALIST SVCS.
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3655
Mailing Address - Country:US
Mailing Address - Phone:815-971-5000
Mailing Address - Fax:815-971-6326
Practice Address - Street 1:2400 N ROCKTON AVE
Practice Address - Street 2:PEDIATRIC HOSPITALIST SVCS.
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3655
Practice Address - Country:US
Practice Address - Phone:815-971-5000
Practice Address - Fax:815-971-6326
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT200569208000000X
IL036135756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics