Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 036148856 | IL |
NPI | 1033539630 |
---|---|
Provider Name | Dr. Mohammad Abdelhafez Issa |
First Address | Kankakee, IL 60901-3493 |
Second Address | Kankakee, IL 60901-3493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2014 |
Last Update Date | 22/03/2021 |