Individual
MR. MOHAMED AFFANEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1254 LACOMA DR, LOCKPORT, IL 60441-3200
(708) 415-8875
(773) 488-1523
Mailing address
1254 LACOMA DR, LOCKPORT, IL 60441-3200
(708) 415-8875
(773) 488-1523
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A15054080159
IL
Other
Enumeration date
03/17/2011
Last updated
03/17/2011
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