MEDICARE: NWI MEDICAL GROUP INC

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
1	207Q00000X	Family Medicine Physician	036121541	IL

General Provider Information

NPI Number	:	1386054104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NWI MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	4054 W NORTH AVE
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60639-5223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4054 W NORTH AVE
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60639-5223
Country	:	US
Telephone Number	:	219-427-0700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FAIZUDDIN SHAREEF
Credential	:
Telephone Number	:	219-427-0700

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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