Healthcare Provider Details

I. General information

NPI: 1679268411
Provider Name (Legal Business Name): TANVEER AHAMAD SHAIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ASCENSION SAINT FRANCIS, 355 RIDGE AVE.
EVANSTON IL
60202
US

IV. Provider business mailing address

355 RIDGE AVE. ASCENSION SAINT FRANCIS
EVANSTON IL
60202
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-4000
  • Fax:
Mailing address:
  • Phone: 847-316-4000
  • Fax: 847-316-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37589
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: