Healthcare Provider Details

I. General information

NPI: 1578720777
Provider Name (Legal Business Name): MOHAMMED A MUBEEN M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 N ASHLAND AVE
CHICAGO IL
60657-3012
US

IV. Provider business mailing address

PO BOX 68698
SCHAUMBURG IL
60168-0698
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-3003
  • Fax: 773-296-3002
Mailing address:
  • Phone: 773-296-3003
  • Fax: 773-296-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number54620-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036129618
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036129618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: