Provider Demographics
NPI:1255386538
Name:WARSI, SYED SHAH M A (MD)
Entity type:Individual
Prefix:DR
First Name:SYED SHAH
Middle Name:M A
Last Name:WARSI
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 1:1033 BENNETT CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542
Mailing Address - Country:US
Mailing Address - Phone:630-844-1818
Mailing Address - Fax:630-844-1429
Practice Address - Street 1:581 SULLIVAN RD
Practice Address - Street 2:SUIT A
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-844-1818
Practice Address - Fax:630-844-1429
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107114207R00000X
IL036-107114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107114Medicaid
ILH79165Medicare UPIN
IL036107114Medicaid
ILL97017Medicare ID - Type UnspecifiedCOOK