Provider Demographics
NPI:1316033640
Name:RAZVI, MOHAMMED M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:M
Last Name:RAZVI
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 1:1120 N MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1477
Mailing Address - Country:US
Mailing Address - Phone:815-432-1078
Mailing Address - Fax:
Practice Address - Street 1:806 E WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1584
Practice Address - Country:US
Practice Address - Phone:815-432-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360473442086S0129X
IN01027217A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100002130Medicaid
IL036047344Medicaid
IN100002130Medicaid
IL036047344Medicaid
IN185700Medicare ID - Type Unspecified