MEDICARE: DR. SHOEB MOHIUDDIN 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	036140752	IL
2	207L00000X	Anesthesiology Physician	036140752	IL

General Provider Information

NPI Number	:	1770928640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOEB MOHIUDDIN M.D.

Provider Business Mailing Address
First Line	:	1740 W TAYLOR ST
Second Line	:	3200W UIH M/C515
City	:	CHICAGO
State	:	IL
Zip	:	60612-7232
Country	:	US
Telephone Number	:	312-996-4021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1658 N MILWAUKEE AVE
Second Line	:	# 295
City	:	CHICAGO
State	:	IL
Zip	:	60647-6905
Country	:	US
Telephone Number	:	312-300-3882
Fax Number	:

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

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	01/12/2022

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