1619060985 NPI number — MR. MOHY M OSMAN P.T

Table of content: MR. MOHY M OSMAN P.T (NPI 1619060985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619060985 NPI number — MR. MOHY M OSMAN P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSMAN
Provider First Name:
MOHY
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619060985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8501 ROB ROY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462-5957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-261-3803
Provider Business Mailing Address Fax Number:
708-570-2936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17577 KEDZIE AVE
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
HAZEL CREST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60429-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-781-9385
Provider Business Practice Location Address Fax Number:
708-570-2936
Provider Enumeration Date:
10/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070-007373 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 198.000441 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)