Individual
MOHAMMAD TABATABAEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1220 W JACKSON ST, SULLIVAN, IL 61951-1032
(217) 728-2042
(217) 728-2485
Mailing address
2300 N EDWARD ST, GSBLL, DECATUR, IL 62526-4163
(217) 876-2857
(217) 876-2874
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002332
IL
Other
Enumeration date
07/17/2006
Last updated
01/10/2023
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