Provider Demographics
NPI:1053337568
Name:SHAIKH, SHABBIR A (MD)
Entity type:Individual
Prefix:
First Name:SHABBIR
Middle Name:A
Last Name:SHAIKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 N ILLINOIS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3419
Mailing Address - Country:US
Mailing Address - Phone:618-233-5000
Mailing Address - Fax:618-233-5040
Practice Address - Street 1:5003 N ILLINOIS ST STE 2
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3419
Practice Address - Country:US
Practice Address - Phone:618-233-5000
Practice Address - Fax:618-233-5040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075000Medicaid
110076104OtherRAILROAD MEDICARE
D16069Medicare UPIN
110076104OtherRAILROAD MEDICARE