Provider Demographics
NPI:1578720777
Name:MUBEEN, MOHAMMED A (MD,)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:A
Last Name:MUBEEN
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:PO BOX 68698
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60168-0698
Mailing Address - Country:US
Mailing Address - Phone:773-296-3003
Mailing Address - Fax:773-296-3002
Practice Address - Street 1:3002 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3012
Practice Address - Country:US
Practice Address - Phone:773-296-3003
Practice Address - Fax:773-296-3002
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54620-20207RN0300X
IL036129618207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036129618Medicaid
IL9800980OtherCIGNA
ILF400238693Medicare PIN