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General NPI Number Information
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NPI Number | 1376291245
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Entity Type | Individual
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Provider Name | MOHAMMED RIHAN AHAMED RIFAI B.SC.
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Gender | Male
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 3300 W LAWRNCE AVE STE 1W
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City | CHICAGO
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State | IL
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Zip | 60625-5203
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Country | US
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Telephone | 574-516-8045
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 W LAWRNCE AVE STE 1W
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City | CHICAGO
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State | IL
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Zip | 60625-5203
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Country | US
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Telephone | 574-516-8045
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 14D2254754
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License Number State | IL
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