Provider Demographics
NPI:1801042999
Name:ALKHAFAJI, MAASAL MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MAASAL
Middle Name:MOHAMMED
Last Name:ALKHAFAJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3462 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5117
Mailing Address - Country:US
Mailing Address - Phone:773-654-1077
Mailing Address - Fax:773-942-6847
Practice Address - Street 1:3462 W LAWRENCE AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-654-1077
Practice Address - Fax:773-942-6847
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine