Healthcare Provider Details

I. General information

NPI: 1922098524
Provider Name (Legal Business Name): MOHAMED S AFIFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 1000
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

251 E HURON ST FEINBURG 8-336
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-9797
  • Fax: 312-695-8341
Mailing address:
  • Phone: 312-695-9797
  • Fax: 312-926-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number036107813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: