Healthcare Provider Details

I. General information

NPI: 1801886593
Provider Name (Legal Business Name): MUHANNAD KAYALI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 OGDEN AVE
BERWYN IL
60402-3685
US

IV. Provider business mailing address

6920 OGDEN AVE
BERWYN IL
60402-3685
US

V. Phone/Fax

Practice location:
  • Phone: 708-482-3118
  • Fax: 708-482-3140
Mailing address:
  • Phone: 708-447-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37720
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64562
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-094540
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37720
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: