Healthcare Provider Details

I. General information

NPI: 1487486650
Provider Name (Legal Business Name): MINNARA ABRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINNARA MATHEW

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N RANDALL RD
ELGIN IL
60123-2300
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-9800
  • Fax: 224-783-3002
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209036368
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041498536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: