Provider Demographics
NPI:1952782518
Name:AASEEMAH MOHAMED, FAKHRUDIN (MD)
Entity Type:Individual
Prefix:
First Name:FAKHRUDIN
Middle Name:
Last Name:AASEEMAH MOHAMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1196
Mailing Address - Country:US
Mailing Address - Phone:773-710-8081
Mailing Address - Fax:
Practice Address - Street 1:940 W STACY RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5214
Practice Address - Country:US
Practice Address - Phone:214-547-0700
Practice Address - Fax:972-992-2428
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144546207Q00000X
TXR9900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine