Provider Demographics
NPI:1760019947
Name:ISMAIL, MOHAMED RAFAT MOHAMED ABDELR (MBBCH)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:RAFAT MOHAMED ABDELR
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ABASAYA ST
Mailing Address - Street 2:APT 6
Mailing Address - City:CAIRO
Mailing Address - State:CAIRO
Mailing Address - Zip Code:11517
Mailing Address - Country:EG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:859-539-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
IL125076012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program