Provider Demographics
NPI:1841369584
Name:SANAD, MOHAMED
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:SANAD
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 1:15601 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD.
Practice Address - Street 2:SUITE 24
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2935
Practice Address - Country:US
Practice Address - Phone:630-887-6929
Practice Address - Fax:630-887-6930
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23976OtherPROVIDER ID NUMBER
IL212618Medicare ID - Type UnspecifiedGROUP NUMBER