Healthcare Provider Details

I. General information

NPI: 1730968397
Provider Name (Legal Business Name): MOHAMMED MIQDAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 S WOOD ST
CHICAGO IL
60612-3747
US

IV. Provider business mailing address

1307 N LAWNDALE AVE APT 1F
CHICAGO IL
60651-2261
US

V. Phone/Fax

Practice location:
  • Phone: 886-600-2273
  • Fax:
Mailing address:
  • Phone: 929-683-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number125.085108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: