Provider Demographics
NPI:1679739197
Name:SALLAJ, ABDULLAH K (MD)
Entity type:Individual
Prefix:DR
First Name:ABDULLAH
Middle Name:K
Last Name:SALLAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:561 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6068
Mailing Address - Country:US
Mailing Address - Phone:773-906-4546
Mailing Address - Fax:
Practice Address - Street 1:561 W DIVERSEY PKWY STE 215
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1682
Practice Address - Country:US
Practice Address - Phone:773-906-4546
Practice Address - Fax:773-304-4549
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2023-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0361241092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL 5764Medicare PIN