Provider Demographics
NPI:1457098675
Name:ZRAIK, MOHAMAD AHMAD
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:AHMAD
Last Name:ZRAIK
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 1:2345 W RYAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4348
Mailing Address - Country:US
Mailing Address - Phone:414-628-1560
Mailing Address - Fax:
Practice Address - Street 1:2345 W RYAN RD STE B
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4348
Practice Address - Country:US
Practice Address - Phone:414-628-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5761-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor