Provider Demographics
NPI:1245213313
Name:ASHRAF, MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ASHRAF
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 1:227 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1952
Mailing Address - Country:US
Mailing Address - Phone:636-931-2700
Mailing Address - Fax:636-931-5304
Practice Address - Street 1:4 HICKORY RIDGE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5100
Practice Address - Country:US
Practice Address - Phone:636-481-6040
Practice Address - Fax:636-797-5633
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106437207Q00000X
MO2008034880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106437Medicaid
IL036106437Medicaid
ILK13800Medicare ID - Type UnspecifiedMEDICARE