Provider Demographics
NPI:1285163642
Name:FAHS, ABRAHIM ALI (DO)
Entity type:Individual
Prefix:
First Name:ABRAHIM
Middle Name:ALI
Last Name:FAHS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3860
Mailing Address - Country:US
Mailing Address - Phone:630-856-8900
Mailing Address - Fax:630-856-8958
Practice Address - Street 1:12012 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5631
Practice Address - Country:US
Practice Address - Phone:630-340-7197
Practice Address - Fax:813-605-3900
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16977207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine