Healthcare Provider Details

I. General information

NPI: 1790536746
Provider Name (Legal Business Name): MOHAMMAD ABOU EL-EZZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

3110 N SHERIDAN RD APT 1608
CHICAGO IL
60657-4942
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6237
  • Fax: 773-665-6232
Mailing address:
  • Phone: 606-425-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberXXX
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: