Provider Demographics
NPI:1942242979
Name:FATIMA, SHAHEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHEEN
Middle Name:
Last Name:FATIMA
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 1:346 WILSHIRE DR E
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3148
Mailing Address - Country:US
Mailing Address - Phone:773-338-8343
Mailing Address - Fax:773-338-8349
Practice Address - Street 1:7133 N RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3613
Practice Address - Country:US
Practice Address - Phone:773-338-8343
Practice Address - Fax:773-338-8349
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH55856Medicare UPIN