Healthcare Provider Details

I. General information

NPI: 1184472268
Provider Name (Legal Business Name): MOMEN ABBASI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 08/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S. WOOD STREET UNIVERSITY OF ILLINOIS CHICAGO DIVISION OF NEPHROLOGY M
CHICAGO IL
60612
US

IV. Provider business mailing address

820 S. WOOD STREET UNIVERSITY OF ILLINOIS CHICAGO DIVISION OF NEPHROLOGY M
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6736
  • Fax: 312-996-7378
Mailing address:
  • Phone: 312-996-6736
  • Fax: 312-996-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number125.083087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: