Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 125.074147 | IL |
Y | 111NI0900X | Internist | 125.074147 | IL |
NPI | 1003377565 |
---|---|
Provider Name | Ashley Mohan |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Evanston, IL 60201-1700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 28/05/2019 |