Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 036129367 | IL |
N | 207VX0000X | Obstetrician | 4301087703 | MI |
NPI | 1225247976 |
---|---|
Provider Name | Mona Mohsen Gomaa |
First Address | Elmwood Park, IL 60707-1113 |
Second Address | Elmwood Park, IL 60707-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 18/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036129367 | (05) | IL |