Provider Demographics
NPI:1588048292
Name:QUADRI, AMINA
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:QUADRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 DORY CIR E
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-6270
Mailing Address - Country:US
Mailing Address - Phone:708-863-2000
Mailing Address - Fax:
Practice Address - Street 1:7250 S CICERO AVE STE F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5849
Practice Address - Country:US
Practice Address - Phone:708-496-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019030261Medicaid