Provider Demographics
NPI:1609873322
Name:YAMANI, MOHAMMAD ILYAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ILYAS
Last Name:YAMANI
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 1:1745 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1852
Mailing Address - Country:US
Mailing Address - Phone:727-587-0377
Mailing Address - Fax:727-587-0527
Practice Address - Street 1:1745 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1852
Practice Address - Country:US
Practice Address - Phone:727-587-0377
Practice Address - Fax:727-587-0527
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32173OtherBCBS
FL250370100Medicaid