Provider Demographics
NPI:1376709063
Name:POONJA, SHIRIN AMLANI (DO)
Entity Type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:AMLANI
Last Name:POONJA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHIRIN
Other - Middle Name:MANSOOR ALI
Other - Last Name:AMLANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D O
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-9000
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126508207R00000X
IL036126508208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine