Provider Demographics
NPI:1720006919
Name:MOLLOHAN, WILLIAM H (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:MOLLOHAN
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:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:EOLA
Mailing Address - State:IL
Mailing Address - Zip Code:60519-0245
Mailing Address - Country:US
Mailing Address - Phone:630-548-5936
Mailing Address - Fax:630-548-5940
Practice Address - Street 1:535 FAIRWAY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3938
Practice Address - Country:US
Practice Address - Phone:630-548-5936
Practice Address - Fax:630-548-5940
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200236Medicaid
ILK08025Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL200236Medicaid
ILC45086Medicare UPIN