Healthcare Provider Details

I. General information

NPI: 1992595821
Provider Name (Legal Business Name): ALIA MOHAMMAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W 95TH ST STE 400
EVERGREEN PARK IL
60805-2755
US

IV. Provider business mailing address

16765 W ONEIDA DR
LOCKPORT IL
60441-4244
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209032180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: