Provider Demographics
NPI:1215250675
Name:MOHAMED, KRISTA R (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:R
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1585 N BARRINGTON RD, DOCTORS' BUILDING 2, SUITE 303
Mailing Address - Street 2:MAJMUDAR ALLERGY
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-781-3002
Mailing Address - Fax:847-781-3694
Practice Address - Street 1:1585 N BARRINGTON RD
Practice Address - Street 2:DOCTORS' BLDG 2, SUITE 303
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2315
Practice Address - Country:US
Practice Address - Phone:847-781-3002
Practice Address - Fax:847-781-3694
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2550-23363A00000X
IL085.003588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant