Provider Demographics
NPI:1588798227
Name:SHAHKHAN, OBAIDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:OBAIDA
Middle Name:
Last Name:SHAHKHAN
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 1:10701 S EWING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-6606
Mailing Address - Country:US
Mailing Address - Phone:773-721-4900
Mailing Address - Fax:773-721-8963
Practice Address - Street 1:10701 S EWING AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-6606
Practice Address - Country:US
Practice Address - Phone:773-721-4900
Practice Address - Fax:773-721-8963
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
K20851Medicare ID - Type Unspecified
ILC47671Medicare UPIN