Individual
DR. FAZAL MOHAMMAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
27 DENNISON DR, GLENDALE HEIGHTS, IL 60139-1876
(630) 664-9273
Mailing address
27 DENNISON DR, GLENDALE HEIGHTS, IL 60139-1876
(630) 664-9273
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01068409A
IN
207Q00000X
Family Medicine Physician
Primary
4301090321
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043414097
—
IN
05
—
200988900
—
IN
Enumeration date
06/13/2007
Last updated
05/16/2012
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