Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 04-38592 | KS |
N | 2084N0402X | Child Neurologist | 2015038376 | MO |
N | 2084N0600X | Clinical Neurophysiologist | 04-38592 | KS |
Y | 2084N0600X | Clinical Neurophysiologist | 2015038376 | MO |
NPI | 1184952954 |
---|---|
Provider Name | Dr. Mohammed Ilyas |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2009 |
Last Update Date | 07/11/2017 |