Provider Demographics
NPI:1548269228
Name:FABI, NANETTE Y (MD)
Entity type:Individual
Prefix:DR
First Name:NANETTE
Middle Name:Y
Last Name:FABI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:18127 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3921
Practice Address - Country:US
Practice Address - Phone:708-474-8844
Practice Address - Fax:708-474-6135
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110139210OtherRRM
IL036089814Medicaid
ILF400460536OtherMEDICARE
ILL57673Medicare PIN
ILDE0914Medicare PIN
IL231199Medicare PIN
ILG13895Medicare UPIN
ILK18260Medicare PIN
IL110139210Medicare PIN
ILL57475Medicare PIN