Provider Demographics
NPI:1558817387
Name:CHICAGO MEDICAL PHYSICIANS LLC
Entity Type:Organization
Organization Name:CHICAGO MEDICAL PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:331-205-5998
Mailing Address - Street 1:3350 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-5114
Mailing Address - Country:US
Mailing Address - Phone:312-971-7929
Mailing Address - Fax:312-868-0994
Practice Address - Street 1:3350 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-5114
Practice Address - Country:US
Practice Address - Phone:312-971-7929
Practice Address - Fax:312-868-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty