Provider Demographics
NPI:1588213094
Name:MOHAMED, MAHMOUD (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:MOHAMED
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 1:9125 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1441
Mailing Address - Country:US
Mailing Address - Phone:708-422-7715
Mailing Address - Fax:708-422-7816
Practice Address - Street 1:9125 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1441
Practice Address - Country:US
Practice Address - Phone:708-422-7715
Practice Address - Fax:708-422-7816
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-4355207R00000X
IL036167476207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine