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NPI Code Detail

MEDICARE: MUNIRA MOUKADDEM

MEDICARE: MUNIRA MOUKADDEM
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
1152W00000XOptometrist046.011787IL

General Provider Information

NPI Number : 1407631708
Entity Type Code : Individual
Provider Name (Legal Business Name) : MUNIRA MOUKADDEM
Provider Business Mailing Address
First Line : 9236 S THOMAS AVE
Second Line :
City : BRIDGEVIEW
State : IL
Zip : 60455-2162
Country : US
Telephone Number : 708-566-7960
Fax Number :
Provider Business Practice Location Address
First Line : 9531 S CICERO AVE
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-3136
Country : US
Telephone Number : 708-423-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 08/28/2023

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Directions to “ MUNIRA MOUKADDEM ” Practice Location

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