Provider Demographics
NPI:1457980062
Name:AHMED, SHIFA MANSOOR
Entity Type:Individual
Prefix:
First Name:SHIFA
Middle Name:MANSOOR
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2228
Mailing Address - Country:US
Mailing Address - Phone:312-532-4625
Mailing Address - Fax:
Practice Address - Street 1:1890 RESEARCH FOREST DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77381-4566
Practice Address - Country:US
Practice Address - Phone:832-658-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5335207Q00000X
PAMT219751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine