Provider Demographics
NPI:1316101181
Name:ABRAHAM, ALIN K (MD)
Entity type:Individual
Prefix:DR
First Name:ALIN
Middle Name:K
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1870
Mailing Address - Country:US
Mailing Address - Phone:630-315-8704
Mailing Address - Fax:630-778-6088
Practice Address - Street 1:1019 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1870
Practice Address - Country:US
Practice Address - Phone:630-315-8800
Practice Address - Fax:630-315-8829
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120485208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400123521OtherMEDICARE PTAN (INDIVDUAL)
IL482450002OtherMEDICARE PTAN (INDIVIDUAL)
IL036120485Medicaid
IL920540OtherMEDICARE PTAN (GROUP)
IL487450OtherMEDICARE PTAN (INDIVIDUAL)
ILP00754679OtherRR MEDICARE