Healthcare Provider Details

I. General information

NPI: 1649253238
Provider Name (Legal Business Name): AGHAWNI SIMON ABRAHAMIAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AGHAWNI SIMON ABRAHAMIAN M.D

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST SUITE 504 W
EVANSTON IL
60202-3439
US

IV. Provider business mailing address

3710 CAPRI CT
GLENVIEW IL
60025-3810
US

V. Phone/Fax

Practice location:
  • Phone: 847-332-2770
  • Fax: 847-332-2778
Mailing address:
  • Phone: 847-332-2770
  • Fax: 847-332-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: