Provider Demographics
NPI:1154452746
Name:IMAM, SHAHEEN A (MD)
Entity Type:Individual
Prefix:
First Name:SHAHEEN
Middle Name:A
Last Name:IMAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E STATE PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4538
Mailing Address - Country:US
Mailing Address - Phone:847-755-5176
Mailing Address - Fax:847-755-5170
Practice Address - Street 1:506 E STATE PKWY
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4538
Practice Address - Country:US
Practice Address - Phone:847-755-5176
Practice Address - Fax:847-755-5170
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36087659207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH93998Medicare UPIN
ILK00964Medicare ID - Type Unspecified