MEDICARE: SHIFA THERAPEUTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036121869	IL

General Provider Information

NPI Number	:	1174965784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFA THERAPEUTICS LLC

Provider Business Mailing Address
First Line	:	1019 GROVE LN
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-2309
Country	:	US
Telephone Number	:	516-521-8983
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 GROVE LN
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-2309
Country	:	US
Telephone Number	:	516-521-8983
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DR. MUHAMMAD NOUMAN AZHAR
Credential	:	M.D.
Telephone Number	:	516-521-8983

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	12/09/2013

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