Individual
MOHAMAD ATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1802 S. MATTIS, CHAMPAIGN, IL 61821
(217) 383-3311
(630) 690-5282
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
(217) 902-5291
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041398787
IL
363L00000X
Nurse Practitioner
Primary
209017185
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209017185
IL
Other
Enumeration date
01/15/2013
Last updated
09/04/2025
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