Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-098125 | IL |
N | 111NI0900X | Internist | 036-098125 | IL |
Y | 207RA0401X | Internist - Addiction Medicine | 036-098125 | IL |
NPI | 1851485312 |
---|---|
Provider Name | Abdel Fahmy |
First Address | Chicago, IL 60661-1259 |
Second Address | Chicago, IL 60661-1259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 10/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H25612 | (02) |