Provider Demographics
NPI:1376291245
Name:AHAMED RIFAI, MOHAMMED RIHAN (BSC)
Entity type:Individual
Prefix:
First Name:MOHAMMED RIHAN
Middle Name:
Last Name:AHAMED RIFAI
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W LAWRNCE AVE STE 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5203
Mailing Address - Country:US
Mailing Address - Phone:574-516-8045
Mailing Address - Fax:
Practice Address - Street 1:3300 W LAWRNCE AVE STE 1W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5203
Practice Address - Country:US
Practice Address - Phone:574-516-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D2254754291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory