Provider Demographics
NPI:1669822318
Name:MOHAMED, BILAL ALI (DO)
Entity Type:Individual
Prefix:DR
First Name:BILAL
Middle Name:ALI
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3799
Mailing Address - Country:US
Mailing Address - Phone:309-268-3502
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3799
Practice Address - Country:US
Practice Address - Phone:309-268-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05738208M00000X, 207Q00000X
IL125.068964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine