Provider Demographics
NPI:1437534997
Name:SHAH, SYED ZIA-UR-REHMAN
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:ZIA-UR-REHMAN
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION,MERCY HOSPITAL AND MEDICAL,
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2315
Mailing Address - Country:US
Mailing Address - Phone:312-567-2167
Mailing Address - Fax:312-567-2628
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION,MERCY HOSPITAL AND MEDICAL,
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2315
Practice Address - Country:US
Practice Address - Phone:312-567-2167
Practice Address - Fax:312-567-2628
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.066530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GB200150OtherCANADIAN PASSPORT