Provider Demographics
NPI:1003568882
Name:SUGHAYER, MOHAMAD (TECHNICAL DIRECTORBA)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:SUGHAYER
Suffix:
Gender:M
Credentials:TECHNICAL DIRECTORBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18013 ALICE LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8433
Mailing Address - Country:US
Mailing Address - Phone:708-904-2424
Mailing Address - Fax:
Practice Address - Street 1:4142 167TH ST STE 6
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3345
Practice Address - Country:US
Practice Address - Phone:708-904-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D2249312Medicaid