Individual
MOHAMMED ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
751 SAPPINGTON BRIDGE RD, SULLIVAN, MO 63080-2354
(573) 468-4186
Mailing address
75 REMITT DRIVE, LOCKBOX 1964, CHICAGO, IL 60675-1964
(866) 916-5259
(231) 922-4060
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
33113
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203230933
—
MO
Enumeration date
07/17/2006
Last updated
02/08/2008
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