Healthcare Provider Details

I. General information

NPI: 1982606950
Provider Name (Legal Business Name): MOHAMMED O PERACHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E WEST RD
CALUMET CITY IL
60409-5415
US

IV. Provider business mailing address

1700 E WEST RD
CALUMET CITY IL
60409-5415
US

V. Phone/Fax

Practice location:
  • Phone: 708-891-3330
  • Fax:
Mailing address:
  • Phone: 708-891-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01059313A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number45488
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number45488
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036123530
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: