Individual
DR. MOHAMMAD ALI KIZILBASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4309 W MEDICAL CENTER DR STE A200, MCHENRY, IL 60050
(815) 759-8070
(815) 759-4931
Mailing address
4309 W MEDICAL CENTER DR STE A200, MCHENRY, IL 60050-8437
(815) 759-8070
(815) 759-4931
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036-111516
IL
207RC0000X
Cardiovascular Disease Physician
2009030104
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036111516
STATE LICENSE
IL
Enumeration date
12/08/2008
Last updated
10/19/2018
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