MEDICARE: DR. WASIF SHIRAZI M.D.

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	207RH0003X	Hematology & Oncology Physician	036099502	IL

General Provider Information

NPI Number	:	1558336149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WASIF SHIRAZI M.D.

Provider Business Mailing Address
First Line	:	17333 LA GRANGE RD
Second Line	:	STE 200
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-7510
Country	:	US
Telephone Number	:	708-342-1900
Fax Number	:	708-745-9993

Provider Business Practice Location Address
First Line	:	17333 LA GRANGE RD STE 200
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-7510
Country	:	US
Telephone Number	:	708-342-1900
Fax Number	:	708-745-9993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	03/17/2018

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