Healthcare Provider Details

I. General information

NPI: 1922432731
Provider Name (Legal Business Name): MAGDY MINA ABOC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525C OGDEN AVE
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

1525C OGDEN AVE
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 630-699-2180
  • Fax:
Mailing address:
  • Phone: 630-699-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number171733
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: