Provider Demographics
NPI:1073551594
Name:SHABBIR, MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:SHABBIR
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 1:900 JORIE BLVD
Mailing Address - Street 2:SUITE 186
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2213
Mailing Address - Country:US
Mailing Address - Phone:630-954-6700
Mailing Address - Fax:
Practice Address - Street 1:900 JORIE BLVD
Practice Address - Street 2:SUITE 186
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2213
Practice Address - Country:US
Practice Address - Phone:630-954-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102808207R00000X, 208M00000X
IL036-102808207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-102808Medicaid
ILF00286044OtherFPN MEDICARE PTAN
ILF00286044OtherFPN MEDICARE PTAN