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General NPI Number Information
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NPI Number | 1679729875
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Entity Type | Individual
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Provider Name | KAIZ SHABBAR ASIF M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 301 MADISON ST STE 300 PEDIATRIC NEUROLOGY
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City | JOLIET
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State | IL
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Zip | 60435-6549
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Country | US
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Telephone | 815-725-4367
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Fax | 815-773-7468
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE STE 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone | 847-570-2040
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Fax | 847-733-5315
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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 | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 036.137686
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036137686
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 54169
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 036137686
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License Number State | IL
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