Healthcare Provider Details

I. General information

NPI: 1093457640
Provider Name (Legal Business Name): EYAD ATIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR
HARVEY IL
60426-3558
US

IV. Provider business mailing address

2400 W WABANSIA AVE APT 211
CHICAGO IL
60647-6824
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036175658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: