Provider Demographics
NPI:1558162461
Name:ANTAR, MOHAMED (MD,)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:ANTAR
Suffix:
Gender:
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 CENTER ST W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-6281
Mailing Address - Country:US
Mailing Address - Phone:507-792-2787
Mailing Address - Fax:
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-6730
Practice Address - Fax:773-665-3401
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program