Healthcare Provider Details

I. General information

NPI: 1003736182
Provider Name (Legal Business Name): SYED SHUJAUDDIN QURESHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SHUJA QURESHI

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 18TH AVE S
GREAT FALLS MT
59405-5160
US

IV. Provider business mailing address

67 TIMBER TRAILS CT
GILBERTS IL
60136-4060
US

V. Phone/Fax

Practice location:
  • Phone: 406-401-8100
  • Fax:
Mailing address:
  • Phone: 224-388-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: