Provider Demographics
NPI:1255596805
Name:MOHAMMED, REEMA (MD)
Entity type:Individual
Prefix:
First Name:REEMA
Middle Name:
Last Name:MOHAMMED
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 1:3340 OAK PARK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3483
Mailing Address - Country:US
Mailing Address - Phone:815-838-7337
Mailing Address - Fax:
Practice Address - Street 1:3340 OAK PARK AVE STE 201
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3483
Practice Address - Country:US
Practice Address - Phone:708-795-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130447Medicaid