Basic Information
| Provider Information | |||||||||
| NPI: | 1326274556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARHAN | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 84992 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606894992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187103710 | ||||||||
| FaxNumber: | 9187700058 | ||||||||
| Practice Location | |||||||||
| Address1: | 10258 SOUTHWEST HWY STE A | ||||||||
| Address2: | |||||||||
| City: | CHICAGO RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604151361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083469533 | ||||||||
| FaxNumber: | 7084994312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301103507 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 036138513 | IL | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036138513 | 05 | IL | MEDICAID |