Provider Demographics
NPI:1285097113
Name:ABRAHAM, JEEVAN CHECHAKUNNIL (MD)
Entity type:Individual
Prefix:
First Name:JEEVAN
Middle Name:CHECHAKUNNIL
Last Name:ABRAHAM
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 1:6155 GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1651
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:224-271-3202
Practice Address - Street 1:6155 GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1651
Practice Address - Country:US
Practice Address - Phone:847-535-7157
Practice Address - Fax:224-271-3202
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.148437207Q00000X
IL036148437207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine