Healthcare Provider Details

I. General information

NPI: 1164836433
Provider Name (Legal Business Name): ABDOULIE NJIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 SOUTH WOOD ST. #835,HECTOEN BLDG DEPT. PLANNING, EDUCATION & RESEARCH - STROGER HOSPITAL
CHICAGO IL
60612
US

IV. Provider business mailing address

1969 W OGDEN AVE
CHICAGO IL
60612-3765
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-0391
  • Fax:
Mailing address:
  • Phone: 312-864-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-146376
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: