Individual
MOHAMMAD F ILYAS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
HIGHWAY 265 WEST & JUNCTION 191 SOUTH, SAGE MEMORIAL HOSPITAL, GANADO, AZ 86505
(928) 755-4500
(928) 755-4659
Mailing address
PO BOX 457, SAGE MEMORIAL HOSPITAL, GANADO, AZ 86505-0457
(928) 755-4500
(928) 755-4659
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
29895
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
649361
—
AZ
01
—
67732089
MEDICAID
NM
Enumeration date
10/17/2005
Last updated
07/08/2007
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