Provider Demographics
NPI:1871527846
Name:ABBASSIAN, MEHRDAD (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:ABBASSIAN
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:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-0869
Mailing Address - Country:US
Mailing Address - Phone:630-321-1115
Mailing Address - Fax:630-321-1116
Practice Address - Street 1:540 OAKMONT LN
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3700
Practice Address - Country:US
Practice Address - Phone:630-321-1115
Practice Address - Fax:630-321-1116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0761652084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29845Medicare PIN
ILE71098Medicare UPIN
ILL72398Medicare PIN