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NPI Code Detail

MEDICARE: SHABAZ GILL MD

MEDICARE: SHABAZ GILL MD
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
1207P00000XEmergency Medicine PhysicianR0005TX
2207Q00000XFamily Medicine Physician036131927IL

General Provider Information

NPI Number : 1598911281
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHABAZ GILL MD
Provider Business Mailing Address
First Line : 1836 S MACARTHUR BLVD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-4030
Country : US
Telephone Number : 217-789-1403
Fax Number : 217-789-1825
Provider Business Practice Location Address
First Line : 1836 S MACARTHUR BLVD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-4030
Country : US
Telephone Number : 217-789-1403
Fax Number : 217-789-1825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2008
Last Update Date : 03/16/2023

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Directions to “ SHABAZ GILL MD” Practice Location

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