Healthcare Provider Details

I. General information

NPI: 1245326222
Provider Name (Legal Business Name): AMIRA FAIZANA MOHAMMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W CHICAGO AVE
EAST CHICAGO IN
46312
US

IV. Provider business mailing address

7231 JEFFREY ST
SCHERERVILLE IN
46375-3512
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-7771
  • Fax: 219-397-1952
Mailing address:
  • Phone: 219-670-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004766A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: