Basic Information
| Provider Information | |||||||||
| NPI: | 1376986547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHIRRI | ||||||||
| FirstName: | MUHANNED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2320 W PETERSON AVE | ||||||||
| Address2: | ATTN:VANESSA CASTORENA | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606595242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735089800 | ||||||||
| FaxNumber: | 7735081796 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 W PETERSON AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606595203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735089300 | ||||||||
| FaxNumber: | 7737612112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 04/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 238000338 | IL | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.