MEDICARE: AHMED KHALAFALLA MOHAMED AHMED MD, MSC

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
1	207RN0300X	Nephrology Physician	125.084616	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1417709213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMED KHALAFALLA MOHAMED AHMED MD, MSC

Provider Business Mailing Address
First Line	:	820 S WOOD ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S WOOD ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-2933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	01/12/2026

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