Provider Demographics
NPI:1699396838
Name:MOLLA, ASHIF KHALED (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHIF
Middle Name:KHALED
Last Name:MOLLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:OSF ST FRANCIS MEDICAL CENTER 530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-624-9351
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER CROSS BLVD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9509
Practice Address - Country:US
Practice Address - Phone:708-478-7201
Practice Address - Fax:708-221-6766
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.166116207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program