Basic Information
Provider Information
NPI: 1972123891
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABDULRASSOUL
FirstName: HUSSEIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 180 HARVESTER DR STE 110
Address2:  
City: BURR RIDGE
State: IL
PostalCode: 605276686
CountryCode: US
TelephoneNumber: 7737021150
FaxNumber:  
Practice Location
Address1: 5841 S MARYLAND AVE # MC3079
Address2:  
City: CHICAGO
State: IL
PostalCode: 606371443
CountryCode: US
TelephoneNumber: 7738343531
FaxNumber: 7737025434
Other Information
ProviderEnumerationDate: 04/21/2020
LastUpdateDate: 04/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X125.075656ILY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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