MEDICARE: MOHAMMAD R ASHRAF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1427120625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAMMAD R ASHRAF MD

Provider Business Mailing Address
First Line	:	103B SOUTHPOINTE
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-3651
Country	:	US
Telephone Number	:	618-692-9640
Fax Number	:	618-692-9643

Provider Business Practice Location Address
First Line	:	1420 20TH ST
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4607
Country	:	US
Telephone Number	:	618-877-8200
Fax Number	:	618-877-8206

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMMAD D ASHRAF
Credential	:	MD
Telephone Number	:	618-877-8200

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	02/04/2008

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