Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036141401 | IL |
N | 208600000X | Surgeon | 036141401 | IL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036141401 | IL |
NPI | 1104018225 |
---|---|
Provider Name | Dr. Farooq Shahzad |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 26/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16282 | (05) | ND |