Healthcare Provider Details

I. General information

NPI: 1629115258
Provider Name (Legal Business Name): ABED RAHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/28/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

6065 S 76TH AVE
SUMMIT IL
60501-1533
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-1903
  • Fax:
Mailing address:
  • Phone: 708-496-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number36112612
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036-112612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: