Healthcare Provider Details

I. General information

NPI: 1679517742
Provider Name (Legal Business Name): MOHAMMAD H ALMACHNOUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
GARY IN
46402-6001
US

IV. Provider business mailing address

4849 W FULLERTON AVE
CHICAGO IL
60639-2503
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-4000
  • Fax:
Mailing address:
  • Phone: 773-237-2900
  • Fax: 773-622-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01080623B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036107638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: