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NPI Code Detail

MEDICARE: MUNA AHMED ELFAKI MOHAMAD

MEDICARE: MUNA AHMED ELFAKI MOHAMAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program125078696IL
2208M00000XHospitalist PhysicianDR0072638CO

General Provider Information

NPI Number : 1154099976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MUNA AHMED ELFAKI MOHAMAD
Provider Business Mailing Address
First Line : 2800 N LAKE SHORE DR APT 3111
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6275
Country : US
Telephone Number : 773-543-6014
Fax Number :
Provider Business Practice Location Address
First Line : 400 W 16TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003
Country : US
Telephone Number : 719-584-4921
Fax Number : 719-595-7994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2021
Last Update Date : 04/26/2024

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Directions to “ MUNA AHMED ELFAKI MOHAMAD ” Practice Location

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