Healthcare Provider Details

I. General information

NPI: 1326960626
Provider Name (Legal Business Name): MOHAMED AHMED ELDEREI M.B.,B.CH., MSC.
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S WOOD STREET, (MC 675) SUITE 100
CHICAGO IL
60612
US

IV. Provider business mailing address

STREET 51,ZONE 66 BLDG 18 ZIGZAG TOWERB, FLAT NO. 3010A
DOHA/WESTBAY LAGOON PLAZA
00000
QA

V. Phone/Fax

Practice location:
  • Phone: 312-996-2933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: