Provider Demographics
NPI:1538119490
Name:NAHHAS, MOHAMED MARWAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:MARWAN
Last Name:NAHHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12307 S HARLEM AVE
Mailing Address - Street 2:1 & 2
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-448-2666
Mailing Address - Fax:
Practice Address - Street 1:12307 S HARLEM AVE
Practice Address - Street 2:1 & 2
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-448-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075723Medicaid
E18685Medicare UPIN
IL036075723Medicaid