Provider Demographics
NPI:1225247976
Name:GOMAA, MONA MOHSEN (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:MOHSEN
Last Name:GOMAA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-1113
Mailing Address - Country:US
Mailing Address - Phone:224-234-6845
Mailing Address - Fax:
Practice Address - Street 1:7613 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-1113
Practice Address - Country:US
Practice Address - Phone:224-234-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129367207VG0400X
MI4301087703207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036129367Medicaid