Provider Demographics
NPI:1154099976
Name:MOHAMAD, MUNA AHMED ELFAKI
Entity type:Individual
Prefix:
First Name:MUNA
Middle Name:AHMED ELFAKI
Last Name:MOHAMAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N LAKE SHORE DR APT 3111
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6275
Mailing Address - Country:US
Mailing Address - Phone:773-543-6014
Mailing Address - Fax:
Practice Address - Street 1:400 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-584-4921
Practice Address - Fax:719-595-7994
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125078696390200000X
CODR0072638208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program