Healthcare Provider Details

I. General information

NPI: 1578191698
Provider Name (Legal Business Name): MOHAMMAD BILAL MEMON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W CENTRAL RD STE 104
ARLINGTON HEIGHTS IL
60005-2465
US

IV. Provider business mailing address

904 ELIZABETH DR
STREAMWOOD IL
60107-4511
US

V. Phone/Fax

Practice location:
  • Phone: 866-607-2308
  • Fax: 248-855-5455
Mailing address:
  • Phone: 866-607-2308
  • Fax: 248-855-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.178129
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0S022723
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: