Provider Demographics
NPI:1629094834
Name:GHUMRA, MOHAMED KASEER (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:KASEER
Last Name:GHUMRA
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 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-2000
Mailing Address - Fax:
Practice Address - Street 1:750 FLETCHER DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4736
Practice Address - Country:US
Practice Address - Phone:847-931-4626
Practice Address - Fax:847-931-4794
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-3867782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086778Medicaid
ILP00098316OtherRAILROAD MEDICARE
IL0004923104OtherBLUE SHIELD
ILP00098316OtherRAILROAD MEDICARE
IL036086778Medicaid
ILK12568Medicare ID - Type Unspecified