Provider Demographics
NPI:1831709153
Name:ELOMARI, MOHAMMAD (APN)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:ELOMARI
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:
Other - Last Name:EL AHMAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17859 MAINE CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9330
Mailing Address - Country:US
Mailing Address - Phone:708-682-5568
Mailing Address - Fax:
Practice Address - Street 1:4901 W 79TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1569
Practice Address - Country:US
Practice Address - Phone:708-499-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021245363LF0000X
IN71012291A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily