Individual
MOHAMMAD ILYAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2024 HICKORY RD, STE 104, HOMEWOOD, IL 60430-2158
(708) 647-9906
(815) 469-0169
Mailing address
2024 HICKORY RD, STE 104, HOMEWOOD, IL 60430-2158
(708) 647-9906
(815) 469-0169
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01044500A
IN
2084P0800X
Psychiatry Physician
036 093224
IL
2084P0800X
Psychiatry Physician
35 07 0335 1
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000203739
ANTHEM BCBS
IN
05
—
200198480A
—
IN
Enumeration date
08/15/2005
Last updated
08/11/2018
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