Provider Demographics
NPI:1508858283
Name:ANSARI, SHEHNAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEHNAZ
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1349
Mailing Address - Country:US
Mailing Address - Phone:217-285-4414
Mailing Address - Fax:217-285-5600
Practice Address - Street 1:623 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1349
Practice Address - Country:US
Practice Address - Phone:217-285-4414
Practice Address - Fax:217-285-5600
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL750590Medicare ID - Type UnspecifiedPROVIDER #
ILE14950Medicare UPIN
IL363560Medicare ID - Type UnspecifiedPROVIDER #