Provider Demographics
NPI:1508854589
Name:IRSHAD, MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:IRSHAD
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 1:638 S BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4742
Mailing Address - Country:US
Mailing Address - Phone:563-244-5900
Mailing Address - Fax:563-244-2801
Practice Address - Street 1:638 S BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4742
Practice Address - Country:US
Practice Address - Phone:563-244-5900
Practice Address - Fax:563-244-2801
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34541207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086296Medicaid
236173OtherMIDLANDS CHOICE
IAP00144291OtherRAILROAD MEDICARE
MO207287608Medicaid
IA2255364Medicaid
IAP00456174OtherRR MC MSC
201487OtherIOWA HEALTH SOLUTIONS
IA01B1OtherJOHN DEERE HC-RIV. VALLEY
097743OtherHEALTH ALLIANCE
37072OtherWELLMARK BC/BS
IA1508854589Medicaid
IA2255364Medicaid
37072OtherWELLMARK BC/BS
097743OtherHEALTH ALLIANCE
MO207287608Medicaid