=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295312551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY ABADIR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2021
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MADISON ST STE 300
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60302-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-486-2700
-----------------------------------------------------
Fax | 708-486-2702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 CHESTNUT RIDGE RD
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-293-8724
-----------------------------------------------------
Fax | 304-293-5323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 036175097
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------