Provider Demographics
NPI:1528013026
Name:ZAIDI, SHAHLA FEROZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAHLA
Middle Name:FEROZ
Last Name:ZAIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3330W. 177TH STREET
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:HAZELCREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429
Mailing Address - Country:US
Mailing Address - Phone:708-957-4278
Mailing Address - Fax:708-799-4177
Practice Address - Street 1:3330W. 177TH STREET
Practice Address - Street 2:SUITE 3D
Practice Address - City:HAZELCREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-957-4278
Practice Address - Fax:708-799-4177
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036085180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF63884Medicare UPIN
IL212526Medicare ID - Type Unspecified