Healthcare Provider Details

I. General information

NPI: 1235624727
Provider Name (Legal Business Name): MAHUM SHAHID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date: 02/13/2019
Reactivation Date: 02/19/2019

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5904
  • Fax: 605-322-8414
Mailing address:
  • Phone: 312-942-5904
  • Fax: 605-322-8414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036173282
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036173282
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: