Provider Demographics
NPI:1770844888
Name:ASIF, MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ASIF
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 1:5995 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6481
Mailing Address - Country:US
Mailing Address - Phone:815-977-4403
Mailing Address - Fax:815-977-5796
Practice Address - Street 1:5995 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6481
Practice Address - Country:US
Practice Address - Phone:815-977-4403
Practice Address - Fax:815-977-5796
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD84088208600000X
PAMT201398208600000X
IL036153451208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery