Fazal Mohammad, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301090321 Issued in MI

Practice address

27 Dennison Dr
Glendale Heights, IL 60139-1876

Phone

(630) 664-9273

NPI assigned

Jun 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Professionals of Indiana, P.C.

  • Emergency Medicine Physician
  • Fort Wayne, IN
  • NPI 1013951219
  Medicare reassignment NPD
• North Indiana Emergency Physicians, LLP

  • Emergency Medicine Physician
  • La Porte, IN
  • NPI 1144691478
  Medicare reassignment NPD
• Northwest Hospitalist Physicians, LLP

  • Emergency Medicine Physician
  • Bloomington, IN
  • NPI 1023448321
  Medicare reassignment NPD
• Northwest Hospitalist Physicians LLP

  • Hospitalist Physician
  • La Porte, IN
  • NPI 1326415423
  NPD
• Maple City Emergency Physicians, LLP

  • Emergency Medicine Physician
  • La Porte, IN
  • NPI 1275558942
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1043414097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 DENNISON DR",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601391876",
            "telephone_number": "630-664-9273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 DENNISON DR",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601391876",
            "telephone_number": "630-664-9273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMMAD",
        "first_name": "FAZAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301090321",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01068409A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043414097",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200988900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Metrowest Care LLC
• Midwest Physical Medicine & Rehab P C
• Miwa Home Care LLC
• MJSZ Optometrist LTD
• Modern Laboratory Incorporated
• Tahseen M Moinuddin, D.C
• Manuela Montoya, NP
• Laura Morris, RN
• Mahira Naseem, RPH
• Paul Nemeth, DO

• Family Medicine Physician in Glendale Heights, IL
• Providers in Glendale Heights, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.