Provider Demographics
NPI:1699090340
Name:ALMOSHELLI, BADER (MD)
Entity type:Individual
Prefix:
First Name:BADER
Middle Name:
Last Name:ALMOSHELLI
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 1:1S450 SUMMIT AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3952
Mailing Address - Country:US
Mailing Address - Phone:630-320-6871
Mailing Address - Fax:630-385-0026
Practice Address - Street 1:1S450 SUMMIT AVE STE 165
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3952
Practice Address - Country:US
Practice Address - Phone:630-320-6871
Practice Address - Fax:630-385-0026
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20176100601208100000X
WI67840208100000X
OH35.121333208100000X
IL036.134581208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-134581Medicaid