Healthcare Provider Details

I. General information

NPI: 1417880980
Provider Name (Legal Business Name): ABDULLAH ABDULWAHID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HAMPTON CT
PLAINFIELD IL
60586-9793
US

IV. Provider business mailing address

1900 HAMPTON CT
PLAINFIELD IL
60586-9793
US

V. Phone/Fax

Practice location:
  • Phone: 773-706-3783
  • Fax:
Mailing address:
  • Phone: 773-706-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86436026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: