Provider Demographics
NPI:1306949367
Name:MOURADI, ADEL (MD)
Entity type:Individual
Prefix:
First Name:ADEL
Middle Name:
Last Name:MOURADI
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 1:1042 MAPLE AVE STE 335
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2329
Mailing Address - Country:US
Mailing Address - Phone:815-300-5376
Mailing Address - Fax:815-300-4848
Practice Address - Street 1:1900 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 2125
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9509
Practice Address - Country:US
Practice Address - Phone:815-300-1100
Practice Address - Fax:815-300-4848
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111174207R00000X
IN01059035A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111174OtherMEDICAL LICENSE
IL204374Medicaid
IL204374Medicaid
IL036111174OtherMEDICAL LICENSE
I08902Medicare UPIN