Provider Demographics
NPI:1689662892
Name:MIRSHED, NAYEH E (MD)
Entity Type:Individual
Prefix:DR
First Name:NAYEH
Middle Name:E
Last Name:MIRSHED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 W 63RD STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5041
Mailing Address - Country:US
Mailing Address - Phone:773-424-4048
Mailing Address - Fax:773-424-6463
Practice Address - Street 1:4255 W 63RD STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5041
Practice Address - Country:US
Practice Address - Phone:773-424-4048
Practice Address - Fax:773-424-6463
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091913Medicaid
IL036091913Medicaid