Individual
MOHAMMED K QAISI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
1969 W OGDEN AVE # CLINICD, CHICAGO, IL 60612-3765
(128) 645-1633
Mailing address
1969 W OGDEN AVE, CHICAGO, IL 60612-3765
(128) 645-1633
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019.030516
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
036.139464
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21459
—
LA
Enumeration date
05/23/2007
Last updated
04/28/2021
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