1619986387 NPI number — DR. MOUHAMMED K SHEIKHA MD

Table of content: DR. MOUHAMMED K SHEIKHA MD (NPI 1619986387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619986387 NPI number — DR. MOUHAMMED K SHEIKHA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEIKHA
Provider First Name:
MOUHAMMED
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1619986387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 PAYSPHERE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-469-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2320 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60406-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-388-5500
Provider Business Practice Location Address Fax Number:
708-388-5672
Provider Enumeration Date:
08/05/2006

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: 207R00000X , with the licence number:  E-0403 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 036088647 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 127261001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110181194 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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