Basic Information
| Provider Information | |||||||||
| NPI: | 1306239918 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ADNAN | ||||||||
| FirstName: | MOHAMMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 W. WHITE RIVER BLVD. | ||||||||
| Address2: | RCS PROVIDER ENROLLMENT | ||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473034988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652544009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 W HARRISON ST | ||||||||
| Address2: | DIVISION OF NEONATOLOGY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128644044 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2015 | ||||||||
| LastUpdateDate: | 05/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01079643A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.