Healthcare Provider Details

I. General information

NPI: 1871527846
Provider Name (Legal Business Name): MEHRDAD ABBASSIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 OAKMONT LN
WESTMONT IL
60559-3700
US

IV. Provider business mailing address

PO BOX 869
LA GRANGE IL
60525-0869
US

V. Phone/Fax

Practice location:
  • Phone: 630-321-1115
  • Fax: 630-321-1116
Mailing address:
  • Phone: 630-321-1115
  • Fax: 630-321-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number036-076165
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: