Healthcare Provider Details

I. General information

NPI: 1134959075
Provider Name (Legal Business Name): MOHAMMAD MUSTAFA ALSHEIKH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER CROSS BLVD
NEW LENOX IL
60451-9509
US

IV. Provider business mailing address

17966 SEMMLER DR
TINLEY PARK IL
60487-8682
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-1100
  • Fax:
Mailing address:
  • Phone: 708-407-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number151982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: