MEDICARE: DR. AHMED SHAFI 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	207Q00000X	Family Medicine Physician	036-098168	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	03222998	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1912997743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED SHAFI M.D.

Provider Business Mailing Address
First Line	:	1368 LIBERTY ST
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-1410
Country	:	US
Telephone Number	:	815-942-8080
Fax Number	:	815-942-0843

Provider Business Practice Location Address
First Line	:	4829 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4234
Country	:	US
Telephone Number	:	773-927-2714
Fax Number	:	773-927-2716

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	11/30/2007

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