Provider Demographics
NPI:1669632964
Name:SHAREEF, AISHA HASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AISHA
Middle Name:HASAN
Last Name:SHAREEF
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 1:5521 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1097
Mailing Address - Country:US
Mailing Address - Phone:219-750-9665
Mailing Address - Fax:219-750-9672
Practice Address - Street 1:5521 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1097
Practice Address - Country:US
Practice Address - Phone:219-750-9665
Practice Address - Fax:219-750-9672
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361210992084N0400X
IN01067804A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000897701OtherANTHEM
IN200975080Medicaid
IN000000989795OtherANTHEM
IN236040157Medicare PIN
IN261970024Medicare PIN