Mohammed Shafiuddin
Individual provider Active NPI Private Vehicle · Hillside, IL
NPI 1669848347 · NPPES record last updated Aug 17, 2015
Key facts
- NPI
- 1669848347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Private Vehicle 347C00000X
- License
- S13554070015 (IL)
- Practice address
- 4844 Butterfield Rd
2R
Hillside, IL 60162-1462 - Phone
- (312) 714-9744
- NPI assigned
- Aug 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S13554070015 | IL | MD | Private Vehicle |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | S13554070015 | IL | Yes |
Addresses
Primary practice location
4844 Butterfield Rd
2R
Hillside, IL 60162-1462
Mailing address
4844 Butterfield Road
Apt #2R
Hillside, IL 60162
Phone (312) 714-9744
Other providers in Hillside, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.