MEDICARE: MOHAMED ABDEL RAHMAN 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	207RN0300X	Nephrology Physician	036062660	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	390006864	OTHER	IL	RR MEDICARE INDIVIDUAL
3	C30486	OTHER	IL	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770580672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED ABDEL RAHMAN MD

Provider Business Mailing Address
First Line	:	120 W 22ND ST
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1557
Country	:	US
Telephone Number	:	630-573-5000
Fax Number	:	630-974-5274

Provider Business Practice Location Address
First Line	:	800 BIESTERFIELD RD STE 104
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3372
Country	:	US
Telephone Number	:	847-981-3680
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/02/2023

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