Provider Demographics
NPI:1679729875
Name:ASIF, KAIZ SHABBAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KAIZ
Middle Name:SHABBAR
Last Name:ASIF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 MADISON ST STE 300
Mailing Address - Street 2:PEDIATRIC NEUROLOGY
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6549
Mailing Address - Country:US
Mailing Address - Phone:815-725-4367
Mailing Address - Fax:815-773-7468
Practice Address - Street 1:301 MADISON ST STE 300
Practice Address - Street 2:PEDIATRIC NEUROLOGY
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6549
Practice Address - Country:US
Practice Address - Phone:815-725-4367
Practice Address - Fax:815-773-7468
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2020-11-04
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Provider Licenses
StateLicense IDTaxonomies
WI541692084N0402X
IL036.1376862084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679729875Medicaid
WI1679729875Medicaid
WI680862709Medicare PIN