Provider Demographics
NPI:1295813996
Name:SHAIK, NAZEER (MD)
Entity Type:Individual
Prefix:
First Name:NAZEER
Middle Name:
Last Name:SHAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NAZEER
Other - Middle Name:
Other - Last Name:SHAIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:801 N LARKIN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3442
Mailing Address - Country:US
Mailing Address - Phone:815-744-7400
Mailing Address - Fax:815-744-7435
Practice Address - Street 1:7604 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1812
Practice Address - Country:US
Practice Address - Phone:708-458-7170
Practice Address - Fax:708-458-7172
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01606583OtherBLUE CROSS BLUE SHIELD
IL036085250Medicaid
ILP00303542OtherRAILROAD MEDICARE
IL01634377OtherBLUE CROSS BLUE SHIELD
IL110145578OtherRAILROAD MEDICARE
IL036085250Medicaid
IL01634377OtherBLUE CROSS BLUE SHIELD
ILK09966Medicare PIN