Individual
IBRAHEEM JAVEED MOHAMMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036164689
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2018
Last updated
09/12/2023
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