Provider Demographics
NPI:1659868719
Name:IJAZ, SHAHNAWAZ CHAUDHRY
Entity Type:Individual
Prefix:
First Name:SHAHNAWAZ
Middle Name:CHAUDHRY
Last Name:IJAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 S UTICA AVE # 14W
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-2930
Mailing Address - Fax:918-744-2203
Practice Address - Street 1:1923 S UTICA AVE # 14W
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-2930
Practice Address - Fax:918-744-2203
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33937207RH0002X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine