Provider Demographics
NPI:1922062694
Name:AZAD, SHAHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:AZAD
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 1:20121 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1009
Mailing Address - Country:US
Mailing Address - Phone:708-704-6787
Mailing Address - Fax:
Practice Address - Street 1:20121 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1009
Practice Address - Country:US
Practice Address - Phone:708-704-6787
Practice Address - Fax:708-679-2551
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105849207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105849Medicaid
ILL99792Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 16
IL036105849Medicaid
H84217Medicare UPIN