Healthcare Provider Details

I. General information

NPI: 1245424217
Provider Name (Legal Business Name): MOHAMED MEGHJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST PAV-3A158
SPRINGFIELD IL
62701-1041
US

IV. Provider business mailing address

250 W KENWOOD AVE
DECATUR IL
62526-4371
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8853
  • Fax: 217-545-0828
Mailing address:
  • Phone: 217-545-8853
  • Fax: 217-545-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: