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General NPI Number Information
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NPI Number | 1992236749
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Entity Type | Individual
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Provider Name | MOHAMMAD ALI AL MAHDAWI M.D
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Gender | Male
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 7836 W JEFFERSON BLVD STE 101
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City | FORT WAYNE
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State | IN
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Zip | 46804-4178
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Country | US
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Telephone | 260-494-3484
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Fax | 260-969-0188
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Provider Business Mailing Address
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Address Line | 120 W 22ND ST
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City | OAK BROOK
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State | IL
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Zip | 60523-1557
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Country | US
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Telephone | 630-573-5000
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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 | 01088553A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301506423
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 01088553A
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License Number State | IN
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