Organization
DR MO S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHOUSE MOHIUDDIN D.O. (PRESIDENT)
(847) 341-0389
Entity
Organization
Contact information
Practice address
2131 W SILVERLEAF LN, ADDISON, IL 60101-6404
(847) 341-0389
Mailing address
2131 W SILVERLEAF LN, ADDISON, IL 60101-6404
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036124315
IL
2084P0804X
Child & Adolescent Psychiatry Physician
036124315
IL
Other
Enumeration date
04/17/2015
Last updated
04/17/2015
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