Healthcare Provider Details

I. General information

NPI: 1306492517
Provider Name (Legal Business Name): MOHAMED HOSSAM ELDEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMED HOSSAM ELDEEN ELDEEN

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

3602 GRENOBLE CT
ROCKFORD IL
61114-7346
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5000
  • Fax:
Mailing address:
  • Phone: 708-551-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number125.073441
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.146307
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036159867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: