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NPI Code Detail

MEDICARE: ABIGAIL TUBMAN

MEDICARE: ABIGAIL TUBMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1170300000XGenetic Counselor (M.S.)246.000973IL

General Provider Information

NPI Number : 1124985866
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL TUBMAN
Provider Business Mailing Address
First Line : 2160 S 1ST AVE RM 260
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-327-2025
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE RM 260
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-327-2025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “ ABIGAIL TUBMAN ” Practice Location

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