Healthcare Provider Details

I. General information

NPI: 1265782668
Provider Name (Legal Business Name): AMIR ABDELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date: 03/23/2018
Reactivation Date: 04/11/2018

III. Provider practice location address

1525 N 12TH ST
MILWAUKEE WI
53205-2591
US

IV. Provider business mailing address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3594
US

V. Phone/Fax

Practice location:
  • Phone: 414-966-3030
  • Fax:
Mailing address:
  • Phone: 628-206-8426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD227931
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number77376
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA164365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: