Provider Demographics
NPI:1407010424
Name:SHAFIQ AHMED, MD, SC
Entity Type:Organization
Organization Name:SHAFIQ AHMED, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-403-3401
Mailing Address - Street 1:15300 WEST AVE
Mailing Address - Street 2:SUITE 222 SOUTH BUILDING
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4600
Mailing Address - Country:US
Mailing Address - Phone:708-403-3401
Mailing Address - Fax:708-403-3403
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:SUITE 222 SOUTH BUILDING
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-403-3401
Practice Address - Fax:708-403-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036041524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036041524Medicaid
IL036041524Medicaid
ILD12204Medicare UPIN