Provider Demographics
NPI:1174589576
Name:DAWOOD, MOHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:DAWOOD
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 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-6860
Mailing Address - Fax:217-876-6868
Practice Address - Street 1:441 W HAY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6324
Practice Address - Country:US
Practice Address - Phone:217-876-6860
Practice Address - Fax:217-876-6868
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112178207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF71593Medicare UPIN
IL036112178Medicaid
ILK11942Medicare ID - Type Unspecified