Provider Demographics
NPI:1902010242
Name:MOHAMMED, RAFAT OWAIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAT
Middle Name:OWAIS
Last Name:MOHAMMED
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 1:11900 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1200
Mailing Address - Country:US
Mailing Address - Phone:708-274-4900
Mailing Address - Fax:708-274-4044
Practice Address - Street 1:11900 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1200
Practice Address - Country:US
Practice Address - Phone:708-274-4900
Practice Address - Fax:708-274-4949
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117171207R00000X
IL036117171207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117171Medicaid
ILP00977000OtherMEDICARE RAIL ROAD
IL910750002Medicare PIN