Basic Information
| Provider Information | |||||||||
| NPI: | 1437151693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YASEEN | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097625560 | ||||||||
| FaxNumber: | 3097627351 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097625560 | ||||||||
| FaxNumber: | 3097627351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 02/28/2014 | ||||||||
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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 | 2080P0206X | 036096361 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 370009042 | 01 | IL | RAILROAD MEDICARE | OTHER | 370009042 | 01 | IL | RAILROAD MEDICARE | OTHER | 036096361 | 05 | IL | MEDICAID |