MEDICARE: OMAR I MOHAMMED MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	69010	TN
2	208M00000X	Hospitalist Physician	036159558	IL
3	207RH0003X	Hematology & Oncology Physician	036159558	IL
4	208M00000X	Hospitalist Physician	69010	TN

General Provider Information

NPI Number	:	1194388710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR I MOHAMMED MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 W SALT CREEK LN
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1008
Country	:	US
Telephone Number	:	224-251-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	06/25/2026

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