MEDICARE: SHIFA DIALYSIS CENTER HUMBOLDT PARK, LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1871146761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFA DIALYSIS CENTER HUMBOLDT PARK, LLC

Provider Business Mailing Address
First Line	:	1658 N MILWAUKEE AVE, SUITE 4
Second Line	:	BOX# 314
City	:	CHICAGO
State	:	IL
Zip	:	60647-6905
Country	:	US
Telephone Number	:	773-232-2300
Fax Number	:	773-232-2301

Provider Business Practice Location Address
First Line	:	1044 N MOZART ST STE 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2789
Country	:	US
Telephone Number	:	773-772-9400
Fax Number	:	773-772-3935

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FARHEEN SHAH-KHAN
Credential	:
Telephone Number	:	773-232-2300

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	06/16/2026

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