Provider Demographics
NPI:1033539630
Name:ISSA, MOHAMMAD ABDELHAFEZ (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ABDELHAFEZ
Last Name:ISSA
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 1:100 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4607
Mailing Address - Country:US
Mailing Address - Phone:815-802-7090
Mailing Address - Fax:815-802-7091
Practice Address - Street 1:100 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4607
Practice Address - Country:US
Practice Address - Phone:815-802-7090
Practice Address - Fax:815-802-7091
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148856208100000X, 208VP0000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine