Provider Demographics
NPI:1033539630
Name:ISSA, MOHAMMAD ABDELHAFEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ABDELHAFEZ
Last Name:ISSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:375 N WALL ST STE P520
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3493
Mailing Address - Country:US
Mailing Address - Phone:815-932-6632
Mailing Address - Fax:815-932-5760
Practice Address - Street 1:375 N WALL ST STE P520
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3493
Practice Address - Country:US
Practice Address - Phone:815-932-6632
Practice Address - Fax:815-932-5760
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036148856208VP0000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine