Provider Demographics
NPI:1013407105
Name:ILAHI, MOHAMMAD-ASAD BUKSH (DPM)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD-ASAD
Middle Name:BUKSH
Last Name:ILAHI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 TUSCAN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3838
Mailing Address - Country:US
Mailing Address - Phone:616-648-0613
Mailing Address - Fax:
Practice Address - Street 1:701 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5209
Practice Address - Country:US
Practice Address - Phone:210-358-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3095213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist