Healthcare Provider Details

I. General information

NPI: 1972565679
Provider Name (Legal Business Name): MOHAMMED M ADIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 WEBER RD
CREST HILL IL
60403-0928
US

IV. Provider business mailing address

800 SHANAHAN CT
NAPERVILLE IL
60540-8219
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-3006
  • Fax: 866-757-6056
Mailing address:
  • Phone: 815-729-3006
  • Fax: 866-757-6056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-095236
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: