MEDICARE: SHAHID ILAHI MD SC

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	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1629077086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHID ILAHI MD SC

Provider Business Mailing Address
First Line	:	520 E 22ND ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6110
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:	630-874-2642

Provider Business Practice Location Address
First Line	:	22285 N PEPPER RD STE 303
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2541
Country	:	US
Telephone Number	:	847-842-0757
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAHID ILAHI
Credential	:
Telephone Number	:	847-842-0757

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/01/2022

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