Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036064496 | IL |
NPI | 1093716276 |
---|---|
Provider Name | Tahmineh Abbasian |
First Address | Chicago, IL 60674-0018 |
Second Address | Glen Ellyn, IL 60137-4464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 20/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036064496 | (05) | IL |
370005588 | RR MEDICARE (01) | IL |