Healthcare Provider Details

I. General information

NPI: 1649477639
Provider Name (Legal Business Name): MOHAMMAD RAED CHEIKHALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W COLUMBIA ST STE 400
EVANSVILLE IN
47710-1782
US

IV. Provider business mailing address

53247 SKYLARK CT
SOUTH BEND IN
46635-1375
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-2031
  • Fax:
Mailing address:
  • Phone: 574-232-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number01043859A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: