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NPI Code Detail

MEDICARE: DR. SHAZAD S AL-KURDI DMD

MEDICARE: DR. SHAZAD S AL-KURDI DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry019.032171IL

General Provider Information

NPI Number : 1376192203
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAZAD S AL-KURDI DMD
Provider Business Mailing Address
First Line : 36W935 WILDMERE DR
Second Line :
City : ELGIN
State : IL
Zip : 60123-4806
Country : US
Telephone Number : 773-551-9490
Fax Number :
Provider Business Practice Location Address
First Line : 9539A S CICERO AVE
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-3136
Country : US
Telephone Number : 773-551-9490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2019
Last Update Date : 09/04/2019

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