Healthcare Provider Details

I. General information

NPI: 1659351278
Provider Name (Legal Business Name): MOHAMMED ASIF MAHKRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 400
AURORA IL
60504-5894
US

IV. Provider business mailing address

2020 OGDEN AVE SUITE 400
AURORA IL
60504-5894
US

V. Phone/Fax

Practice location:
  • Phone: 630-499-2442
  • Fax: 630-499-2452
Mailing address:
  • Phone: 630-499-2442
  • Fax: 630-499-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036085150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: