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General NPI Number Information
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NPI Number | 1417964370
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Entity Type | Individual
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Provider Name | JAWDAT ABBOUD MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 2425 W. 22ND ST. #205
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City | OAK BROOK
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State | IL
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Zip | 60523-1934
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Country | US
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Telephone | 630-974-1400
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Fax | 188-846-6332
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Provider Business Mailing Address
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Address Line | 2425 W.22ND STREET #205
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City | OAK BROOK
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State | IL
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Zip | 60523-1934
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Country | US
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Telephone | 630-974-1400
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036087208
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License Number State | IL
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