MEDICARE: DR. RAFAY ABBASI M.D.

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
1	207R00000X	Internal Medicine Physician	036142136	IL
2	208M00000X	Hospitalist Physician	036142136	IL
3	207R00000X	Internal Medicine Physician	A163388	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14011034	OTHER	IL	CAQH

General Provider Information

NPI Number	:	1447699822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAY ABBASI M.D.

Provider Business Mailing Address
First Line	:	8010 WILLOW GLEN RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1617
Country	:	US
Telephone Number	:	732-501-5497
Fax Number	:

Provider Business Practice Location Address
First Line	:	8010 WILLOW GLEN RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1617
Country	:	US
Telephone Number	:	732-501-5497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	10/15/2024

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