Provider Demographics
NPI:1104814755
Name:ABBASY, IFTIKHARUL H (MD)
Entity type:Individual
Prefix:
First Name:IFTIKHARUL
Middle Name:H
Last Name:ABBASY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3333
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3333
Mailing Address - Country:US
Mailing Address - Phone:630-575-8789
Mailing Address - Fax:630-575-0720
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:SUITE 211
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1245
Practice Address - Country:US
Practice Address - Phone:630-575-8789
Practice Address - Fax:630-575-0720
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10918Medicare UPIN