Basic Information
| Provider Information | |||||||||
| NPI: | 1174888945 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KABBANY | ||||||||
| FirstName: | MOHAMMAD TAREK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3545 W 95TH ST | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608052135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083465562 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3545 W 95TH ST | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608052135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129265136 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036152139 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036.152139 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD043489 | DC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RC0000X | 036.152139 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.