Healthcare Provider Details

I. General information

NPI: 1669784872
Provider Name (Legal Business Name): SHAHAAB UDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

3 ERIE CT SUITE L-700
OAK PARK IL
60302-2519
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-7701
  • Fax: 812-981-6505
Mailing address:
  • Phone: 708-763-1222
  • Fax: 708-763-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01073189B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036131145
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125058873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: