Basic Information
| Provider Information | |||||||||
| NPI: | 1245213313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHRAF | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630281952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369312700 | ||||||||
| FaxNumber: | 6369315304 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 HICKORY RIDGE RD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630505100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364816040 | ||||||||
| FaxNumber: | 6367975633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 01/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036106437 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2008034880 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036106437 | 05 | IL | MEDICAID |