Provider Demographics
NPI:1265194120
Name:A MOHAMMED, ANSAR
Entity type:Individual
Prefix:
First Name:ANSAR
Middle Name:
Last Name:A MOHAMMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 N ARTESIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5356
Mailing Address - Country:US
Mailing Address - Phone:773-852-7866
Mailing Address - Fax:
Practice Address - Street 1:6424 N ARTESIAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-5356
Practice Address - Country:US
Practice Address - Phone:773-852-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2024-05-16
Deactivation Date:2021-10-09
Deactivation Code:
Reactivation Date:2024-05-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory