Provider Demographics
NPI:1245326222
Name:MOHAMMED, AMIRA FAIZANA
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:FAIZANA
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7231 JEFFREY ST
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3512
Mailing Address - Country:US
Mailing Address - Phone:219-670-4288
Mailing Address - Fax:
Practice Address - Street 1:525 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312
Practice Address - Country:US
Practice Address - Phone:219-397-7771
Practice Address - Fax:219-397-1952
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004766A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist