Provider Demographics
NPI:1386650885
Name:EL-SHIKH, TAREK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:EL-SHIKH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5764 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1643
Mailing Address - Country:US
Mailing Address - Phone:773-284-0888
Mailing Address - Fax:773-284-0880
Practice Address - Street 1:5764 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1643
Practice Address - Country:US
Practice Address - Phone:773-284-0888
Practice Address - Fax:773-284-0880
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.006954225100000X
IN05003251A174400000X
IL070006954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201070AOtherMEDICARE PTAN
IN650026089OtherMEDICARE RAIL ROAD
2157528OtherFIRST HEALTH
IN000000277684OtherBC/BS ANTHEM
IL90001118OtherBC/BS OF ILLINOIS
ILIL 5301001OtherMEDICARE PTAN