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General NPI Number Information
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NPI Number | 1205828449
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Entity Type | Individual
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Provider Name | MOHAMMAD ILYAS MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 08/11/2018
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Provider Practice Location Address
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Address Line | 2024 HICKORY RD STE 104
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City | HOMEWOOD
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State | IL
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Zip | 60430-2158
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Country | US
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Telephone | 708-647-9906
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Fax | 815-469-0169
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Provider Business Mailing Address
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Address Line | 2024 HICKORY RD STE 104
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City | HOMEWOOD
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State | IL
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Zip | 60430-2158
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Country | US
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Telephone | 708-647-9906
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Fax | 815-469-0169
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01044500A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036 093224
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35 07 0335 1
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License Number State | OH
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