MEDICARE: SHIFA CARDIOLOGY CONSULTANTS 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	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01633016	OTHER	IL	BCBSPROVIDER NUMBER

General Provider Information

NPI Number	:	1720131014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFA CARDIOLOGY CONSULTANTS MD SC

Provider Business Mailing Address
First Line	:	4640 N MARINE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5719
Country	:	US
Telephone Number	:	773-564-5900
Fax Number	:	773-564-5911

Provider Business Practice Location Address
First Line	:	4640 N MARINE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5719
Country	:	US
Telephone Number	:	773-564-5900
Fax Number	:	773-564-5911

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. AMJAD I SHEIKH
Credential	:	MD
Telephone Number	:	773-564-5900

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/24/2009

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