Provider Demographics
NPI:1386714046
Name:CHOUDRY, ABDUSSALAM (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUSSALAM
Middle Name:
Last Name:CHOUDRY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 MANNING RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4309
Mailing Address - Country:US
Mailing Address - Phone:630-418-0503
Mailing Address - Fax:
Practice Address - Street 1:1921 MANNING RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-4309
Practice Address - Country:US
Practice Address - Phone:630-418-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360944632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0366094463Medicaid
ILH19303Medicare UPIN
IL952720Medicare ID - Type Unspecified