Healthcare Provider Details

I. General information

NPI: 1932442613
Provider Name (Legal Business Name): ABDULLAH ABDUSSALAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RAND RD STE 120
DES PLAINES IL
60016-2359
US

IV. Provider business mailing address

1400 S MICHIGAN AVE APT 1203
CHICAGO IL
60605-3720
US

V. Phone/Fax

Practice location:
  • Phone: 312-767-3244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036169814
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberS1745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: