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General NPI Number Information
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NPI Number | 1124361324
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Entity Type | Individual
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Provider Name | SAMIR F ABBOUD MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST STE 800
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-926-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-926-9000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036139678
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License Number State | IL
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