Provider Demographics
NPI:1063538353
Name:JABRI, MOHAMED N (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:N
Last Name:JABRI
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 1:303 E ARMY TRAIL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2169
Mailing Address - Country:US
Mailing Address - Phone:630-980-6227
Mailing Address - Fax:630-980-2297
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-980-6227
Practice Address - Fax:630-980-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079512174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079512Medicaid
IL036079512Medicaid