Healthcare Provider Details

I. General information

NPI: 1235137928
Provider Name (Legal Business Name): SHAZIA DAUDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12151 REGENCY PKWY STE 12165
HUNTLEY IL
60142-7644
US

IV. Provider business mailing address

12151 REGENCY PKWY STE 12165
HUNTLEY IL
60142-7644
US

V. Phone/Fax

Practice location:
  • Phone: 847-230-9808
  • Fax: 847-984-1915
Mailing address:
  • Phone: 847-230-9808
  • Fax: 847-984-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036111912
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: