Provider Demographics
NPI:1306492517
Name:HOSSAM ELDEEN, MOHAMED NABEEL (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:NABEEL
Last Name:HOSSAM ELDEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMED
Other - Middle Name:
Other - Last Name:ELDEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ELDEEN
Mailing Address - Street 1:3010 OTTER CT
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2381
Mailing Address - Country:US
Mailing Address - Phone:708-551-5309
Mailing Address - Fax:
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0734412085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology