Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 019-020579 | IL |
N | 213EG0000X | General Practice | 019-020579 | IL |
Y | 1223P0300X | Periodontist | 02101463 | IL |
NPI | 1104846609 |
---|---|
Provider Name | Dr. Basem Bruce Abdullah |
First Address | Hinsdale, IL 60521-4614 |
Second Address | Arlington Heights, IL 60005-4373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 21/07/2008 |