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General NPI Number Information
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NPI Number | 1528042975
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Entity Type | Individual
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Provider Name | ISSA ABEDMAHMOUD MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 3020 S PARK AVE
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City | HERRIN
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State | IL
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Zip | 62948-3721
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Country | US
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Telephone | 618-988-1877
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Fax | 618-988-8578
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Provider Business Mailing Address
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Address Line | PO BOX 1096
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City | HERRIN
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State | IL
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Zip | 62948-1096
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Country | US
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Telephone | 618-988-1877
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Fax | 618-988-8578
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 036097793
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License Number State | IL
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