Individual provider Active NPI

Abdullah K Sallaj, M.D.

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1679739197
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036124109 Issued in IL
Practice address
561 W Diversey Pkwy Ste 215
Chicago, IL 60614-1682
Phone
(773) 906-4546
Fax
(773) 304-4549
NPI assigned
Aug 4, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036124109 IL Primary

Addresses

Primary practice location

561 W Diversey Pkwy Ste 215
Chicago, IL 60614-1682

Mailing address

561 W Diversey Pkwy
Suite 215
Chicago, IL 60614-6068
Phone (773) 906-4546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036124109ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Able Psychiatry LLC Psychiatry CurrentSince Nov 19, 2023 Accepting new patients

Locations

561 W Diversey Pkwy
Ste 215
Chicago, IL 60614
Phone (773) 906-4546

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1679739197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "561 W DIVERSEY PKWY",
            "address_2": "SUITE 215",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606146068",
            "telephone_number": "773-906-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "561 W DIVERSEY PKWY STE 215",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141682",
            "telephone_number": "773-906-4546",
            "fax_number": "773-304-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLAJ",
        "first_name": "ABDULLAH",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-04",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036124109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.