Provider Demographics
NPI:1225032626
Name:SHAIKH, AJAZUDDIN Z (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAZUDDIN
Middle Name:Z
Last Name:SHAIKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0760
Practice Address - Street 1:611 E DOUGLAS RD
Practice Address - Street 2:STE 208
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-232-5928
Practice Address - Fax:574-232-4888
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031409A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000805966OtherBCBS
IN100223190AMedicaid
IN100223190Medicaid
IN187730009Medicare PIN
IN100223190Medicaid
IN000000805966OtherBCBS
IN100223190AMedicaid