Healthcare Provider Details

I. General information

NPI: 1134449713
Provider Name (Legal Business Name): SHAZEL GHARBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 N SEDGWICK ST
CHICAGO IL
60610-1818
US

IV. Provider business mailing address

1341 N SEDGWICK ST
CHICAGO IL
60610-1818
US

V. Phone/Fax

Practice location:
  • Phone: 312-643-1689
  • Fax: 312-643-1689
Mailing address:
  • Phone: 312-643-1689
  • Fax: 312-643-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.128691
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.128691
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: