Healthcare Provider Details

I. General information

NPI: 1902818263
Provider Name (Legal Business Name): EDWARD ABRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

835 S WOLCOTT AVE MC 844
CHICAGO IL
60612-3748
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone: 312-996-7161
  • Fax: 312-996-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-048615
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: