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General NPI Number Information
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NPI Number | 1063686939
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Entity Type | Organization
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Legal Business Name | MOHAMMAD ABTAHI M.D.
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1400 E GOLF RD STE 222
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City | DES PLAINES
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State | IL
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Zip | 60016-8821
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Country | US
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Telephone | 847-375-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E GOLF RD STE 222
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City | DES PLAINES
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State | IL
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Zip | 60016-8821
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Country | US
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Telephone | 847-375-0888
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | MOHAMMAD ABTAHI
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Credential | M.D.
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Telephone | 847-375-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036077353
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License Number State | IL
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