Provider Demographics
NPI:1093195968
Name:RACHID, MOHAMAD
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:RACHID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MOHAMAD
Other - Middle Name:
Other - Last Name:RACHID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10604 SOUTHWEST HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2717
Mailing Address - Country:US
Mailing Address - Phone:708-422-0636
Mailing Address - Fax:
Practice Address - Street 1:10604 SOUTHWEST HWY STE 107
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2717
Practice Address - Country:US
Practice Address - Phone:708-422-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036144060207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program