Healthcare Provider Details

I. General information

NPI: 1871596817
Provider Name (Legal Business Name): HOMER ABIAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 CICERO AVE
OAK FOREST IL
60452-4006
US

IV. Provider business mailing address

15900 CICERO AVE
OAK FOREST IL
60452-4006
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-4133
  • Fax: 708-633-3029
Mailing address:
  • Phone: 708-633-4133
  • Fax: 708-633-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-090881
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number336-063910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: