Healthcare Provider Details

I. General information

NPI: 1720605751
Provider Name (Legal Business Name): SHAHZAD NOOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 OZANAM AVE
MORTON GROVE IL
60053-1059
US

IV. Provider business mailing address

9514 OZANAM AVE
MORTON GROVE IL
60053-1059
US

V. Phone/Fax

Practice location:
  • Phone: 414-488-4575
  • Fax: 224-251-8319
Mailing address:
  • Phone: 414-488-4575
  • Fax: 224-251-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: