Provider Demographics
NPI:1043473747
Name:AHMED SHAFI P C
Entity Type:Organization
Organization Name:AHMED SHAFI P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-887-0641
Mailing Address - Street 1:9101 DEVON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8368
Mailing Address - Country:US
Mailing Address - Phone:630-887-0641
Mailing Address - Fax:866-261-3402
Practice Address - Street 1:9101 DEVON RIDGE DR
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8368
Practice Address - Country:US
Practice Address - Phone:630-887-0641
Practice Address - Fax:866-261-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1912997743OtherNPI
IL036098168Medicaid
IL036098168Medicaid