Provider Demographics
NPI:1205828449
Name:ILYAS, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:ILYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 HICKORY RD
Mailing Address - Street 2:STE 104
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2158
Mailing Address - Country:US
Mailing Address - Phone:708-647-9906
Mailing Address - Fax:815-469-0169
Practice Address - Street 1:2024 HICKORY RD
Practice Address - Street 2:STE 104
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2158
Practice Address - Country:US
Practice Address - Phone:708-647-9906
Practice Address - Fax:815-469-0169
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044500A2084P0800X
IL036 0932242084P0800X
OH35 07 0335 12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000203739OtherANTHEM BCBS
IN200198480AMedicaid
IN945770VMedicare PIN
G47902Medicare UPIN