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General NPI Number Information
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NPI Number | 1316063399
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Entity Type | Individual
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Provider Name | MOHAMED E NASR M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 213 S MILWAUKEE AVE
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City | LAKE VILLA
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State | IL
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Zip | 60046-8551
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Country | US
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Telephone | 847-356-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 213 S MILWAUKEE AVE
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City | LAKE VILLA
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State | IL
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Zip | 60046-8551
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Country | US
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Telephone | 847-356-9009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-058768
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036-058768
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 036058768
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036058768
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 036058768
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036058768
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License Number State | IL
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