MEDICARE: MOHAMED HATAB

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	208M00000X	Hospitalist Physician	036175061	IL
2	207Q00000X	Family Medicine Physician	2024-02134	NC
3	207Q00000X	Family Medicine Physician	036175061	IL
4	207Q00000X	Family Medicine Physician	75606	MN

General Provider Information

NPI Number	:	1558949578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED HATAB

Provider Business Mailing Address
First Line	:	1005 BROADWAY ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-2834
Country	:	US
Telephone Number	:	217-223-1200
Fax Number	:	217-277-8988

Provider Business Practice Location Address
First Line	:	3270 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4512
Country	:	US
Telephone Number	:	612-775-1800
Fax Number	:

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/10/2026

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