Healthcare Provider Details

I. General information

NPI: 1760617286
Provider Name (Legal Business Name): SHUA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 BURR RIDGE PKWY
BURR RIDGE IL
60527-6485
US

IV. Provider business mailing address

1133 LAUREL LN
NAPERVILLE IL
60540-7834
US

V. Phone/Fax

Practice location:
  • Phone: 630-321-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ATHER MALIK
Title or Position: PRESIDENT
Credential: D.O
Phone: 630-321-9010