Provider Demographics
NPI:1235137928
Name:DAUDI, SHAZIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAZIA
Middle Name:
Last Name:DAUDI
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 1:12151 REGENCY PKWY STE 12165
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7644
Mailing Address - Country:US
Mailing Address - Phone:847-230-9808
Mailing Address - Fax:847-984-1915
Practice Address - Street 1:12151 REGENCY PKWY STE 12165
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7644
Practice Address - Country:US
Practice Address - Phone:847-230-9808
Practice Address - Fax:847-984-1915
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111912Medicaid
IL036111912Medicaid