Provider Demographics
NPI:1932376746
Name:ALGHOUL, MOHAMMED S (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:S
Last Name:ALGHOUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST
Mailing Address - Street 2:19-250
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:312-695-6022
Mailing Address - Fax:312-695-5672
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:19-250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-6022
Practice Address - Fax:312-695-5672
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090451390200000X
WI55791208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program