Provider Demographics
NPI:1265795140
Name:AL-KAZAZ, MOHAMED MH (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MH
Last Name:AL-KAZAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2981
Mailing Address - Country:US
Mailing Address - Phone:312-664-3278
Mailing Address - Fax:312-695-0063
Practice Address - Street 1:676 N SAINT CLAIR ST STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2981
Practice Address - Country:US
Practice Address - Phone:312-664-3278
Practice Address - Fax:312-695-0063
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036157829207RC0000X
NY292291207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease