Healthcare Provider Details

I. General information

NPI: 1831709153
Provider Name (Legal Business Name): MOHAMMAD ELOMARI APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMAD EL AHMAD

II. Dates (important events)

Enumeration Date: 08/01/2020
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 W 79TH ST FL 2
BURBANK IL
60459-1569
US

IV. Provider business mailing address

17859 MAINE CT
ORLAND PARK IL
60467-9330
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-1545
  • Fax:
Mailing address:
  • Phone: 708-682-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021245
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012291A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: