Provider Demographics
NPI:1144550088
Name:ABRAHAM, MOHAN C (MD)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:C
Last Name:ABRAHAM
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 1:1926 W HARRISON ST
Mailing Address - Street 2:APT 209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3737
Mailing Address - Country:US
Mailing Address - Phone:312-799-9214
Mailing Address - Fax:
Practice Address - Street 1:1900 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3736
Practice Address - Country:US
Practice Address - Phone:312-864-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-27
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124678207R00000X
IL036-124678207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine