Healthcare Provider Details

I. General information

NPI: 1760205389
Provider Name (Legal Business Name): MR. AFAQ ALI SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 STONEHAVEN DR
PLAINFIELD IL
60586-8120
US

IV. Provider business mailing address

2242 STONEHAVEN DR
PLAINFIELD IL
60586-8120
US

V. Phone/Fax

Practice location:
  • Phone: 312-863-9386
  • Fax:
Mailing address:
  • Phone: 312-863-9386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberS000-0018-7319
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: