Healthcare Provider Details

I. General information

NPI: 1497921761
Provider Name (Legal Business Name): MOHAMMED ABDUS SAMEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 N WILTON AVE 2ND FLOOR
CHICAGO IL
60657-6710
US

IV. Provider business mailing address

3815 HIGHLAND AVE
DOWNERS GROVE IL
60515-1500
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-5424
  • Fax: 773-296-5280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125052158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: