Healthcare Provider Details

I. General information

NPI: 1760995161
Provider Name (Legal Business Name): LEENA ABED HAMDAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST FL 1
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST FL 1
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-694-7000
  • Fax: 312-926-6274
Mailing address:
  • Phone: 312-694-7000
  • Fax: 312-926-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085006428
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: