MEDICARE: AMANDA ELISE MOHAMMED-STRAIT MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	R8060	TX

General Provider Information

NPI Number	:	1891172839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ELISE MOHAMMED-STRAIT MD

Provider Business Mailing Address
First Line	:	30 W MONROE ST STE 1200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-2420
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1760
Country	:	US
Telephone Number	:	214-305-7065
Fax Number	:	469-574-0383

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	11/13/2024

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