Provider Demographics
NPI:1376986547
Name:GHIRRI, MUHANNED (RSA)
Entity Type:Individual
Prefix:MR
First Name:MUHANNED
Middle Name:
Last Name:GHIRRI
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 W PETERSON AVE
Mailing Address - Street 2:ATTN:VANESSA CASTORENA
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5242
Mailing Address - Country:US
Mailing Address - Phone:773-508-9800
Mailing Address - Fax:773-508-1796
Practice Address - Street 1:2300 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5203
Practice Address - Country:US
Practice Address - Phone:773-508-9300
Practice Address - Fax:773-761-2112
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000338246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant