Healthcare Provider Details

I. General information

NPI: 1659104230
Provider Name (Legal Business Name): AHMED TAHA ABDALLA ABDELKADER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE
CHICAGO IL
60649-3993
US

IV. Provider business mailing address

860 FOXWORTH BLVD APT 403
LOMBARD IL
60148-6435
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7310
  • Fax:
Mailing address:
  • Phone: 773-947-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.085052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: