Healthcare Provider Details

I. General information

NPI: 1730508052
Provider Name (Legal Business Name): MOHAMMAD ALI ABBASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5620
  • Fax: 312-695-2729
Mailing address:
  • Phone: 312-695-5620
  • Fax: 312-695-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.133719
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036153116
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: