Provider Demographics
NPI:1023099645
Name:SHAIKH, ILYAS AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:ILYAS
Middle Name:AHMED
Last Name:SHAIKH
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 1:4325 DOWNTOWNER LOOP N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5501
Mailing Address - Country:US
Mailing Address - Phone:251-460-9095
Mailing Address - Fax:251-288-5656
Practice Address - Street 1:4325 DOWNTOWNER LOOP N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5501
Practice Address - Country:US
Practice Address - Phone:251-460-9095
Practice Address - Fax:251-460-4666
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL208422084N0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00094473Medicaid
AL00094473Medicare ID - Type Unspecified
AL00094473Medicaid