Provider Demographics
NPI:1548231558
Name:AHMED, SHAHEENA (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAHEENA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2545
Mailing Address - Country:US
Mailing Address - Phone:847-410-6501
Mailing Address - Fax:847-674-2075
Practice Address - Street 1:8320 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-410-6501
Practice Address - Fax:847-674-2075
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.110024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
700F11016OtherBLUE CROSS BLUE SHIELD
MI5315017210OtherCDS
ILBA9348980OtherDEA
36280OtherHEALTH PLAN OF MICHIGAN
MI5315017210OtherCDS
MI5315017210OtherCDS