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General NPI Number Information
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NPI Number | 1043453806
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Entity Type | Individual
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Provider Name | SHERAZUDDIN QURESHI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 20060 GOVERNORS DR
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461
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Country | US
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Telephone | 815-824-4406
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Fax |
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Provider Business Mailing Address
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Address Line | 845 S CATHERINE AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2830
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Country | US
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Telephone | 617-372-0304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036141475
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036141475
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License Number State | IL
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