Healthcare Provider Details

I. General information

NPI: 1275729436
Provider Name (Legal Business Name): MONI ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 E SCHILLER ST
ELMHURST IL
60126-2816
US

IV. Provider business mailing address

4201 WINFIELD RD
WARRENVILLE IL
60555-4025
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9001
  • Fax: 331-221-2315
Mailing address:
  • Phone: 331-221-6377
  • Fax: 331-221-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036121262
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: