Fizan Abdullah, M.D.
Individual provider Active NPI Pediatric Surgery Physician · Maywood, IL
NPI 1689637472 · NPPES record last updated May 6, 2021
Key facts
- NPI
- 1689637472
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Surgery Physician 2086S0120X
- License
- 036138914 (IL)
- Practice address
- 2160 S 1St Ave
Maywood, IL 60153-3328 - Phone
- (708) 216-9000
- NPI assigned
- Apr 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181109001220 | IL | Practitioner - General Surgery |
9830116482 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Humboldt Park Health | Surgery | Current |
Accepting new patients |
| Kids Surgery LTD | Past |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
1044 N Mozart St
#200
Chicago, IL 60622
Phone (773) 292-8227
1044 N Mozart St
Ste 100
Chicago, IL 60622
Phone (773) 292-8247
1044 N Francisco Ave
Chicago, IL 60622
Phone (773) 292-8227
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | D63677 | MD | |
| Pediatric Surgery Physician | 2086S0120X | 036138914 | IL | Yes |
Addresses
Primary practice location
2160 S 1St Ave
Maywood, IL 60153-3328
Mailing address
2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-9000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 409107800 | Medicaid | MD |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | fabdullah87485@direct.luhs.org | Direct |
Other providers in Maywood, IL
- Samer Abdelsamie
- Zaid M Abdelsattar
- Gerges Abdelsayed
- Shahad Abdulameer
- Boraan Abdulkarim
- Hany S Abed
- Ayokunle Temidayo Abegunde
- Gerard J Abood
- Lynn Abplanalp
- Brianna Abraham
All providers in Maywood, IL · Pediatric Surgery Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.