MEDICARE: DR. SHAFIQUE AHMAD 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
1	208000000X	Pediatrics Physician	036048376	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700973229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAFIQUE AHMAD MD

Provider Business Mailing Address
First Line	:	3165 MYRTLE AVE
Second Line	:	SUITE 2
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5012
Country	:	US
Telephone Number	:	618-876-7500
Fax Number	:	618-876-0807

Provider Business Practice Location Address
First Line	:	3165 MYRTLE AVE
Second Line	:	SUITE 2
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5012
Country	:	US
Telephone Number	:	618-876-7500
Fax Number	:	618-876-0807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	01/26/2015

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