Provider Demographics
NPI:1487034203
Name:MOHAMED, SULEIMAN SR
Entity Type:Individual
Prefix:
First Name:SULEIMAN
Middle Name:
Last Name:MOHAMED
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87684
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-0684
Mailing Address - Country:US
Mailing Address - Phone:773-580-4350
Mailing Address - Fax:
Practice Address - Street 1:1434 W OLIVE AVE # 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4229
Practice Address - Country:US
Practice Address - Phone:773-580-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-06
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver