Healthcare Provider Details

I. General information

NPI: 1013983436
Provider Name (Legal Business Name): SHOKRY TAWFIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2006
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W MAIN ST
LENA IL
61048-9247
US

IV. Provider business mailing address

421 W EXCHANGE ST PO BOX 268
FREEPORT IL
61032-4030
US

V. Phone/Fax

Practice location:
  • Phone: 815-369-3300
  • Fax: 815-369-4262
Mailing address:
  • Phone: 815-599-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036065228
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: