Individual
MOHAMMAD REZA S ASHRAF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1420 20TH ST, GRANITE CITY, IL 62040-4607
(618) 877-8200
(618) 877-8206
Mailing address
1420 20TH ST, GRANITE CITY, IL 62040-4607
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036048540
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048540
—
IL
Enumeration date
10/12/2006
Last updated
07/06/2016
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