Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 20842 | AL |
N | 208D00000X | General Practice Physician | 20842 | AL |
NPI | 1023099645 |
---|---|
Provider Name | Dr. Ilyas Ahmed Shaikh |
First Address | Mobile, AL 36609-5501 |
Second Address | Mobile, AL 36609-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 16/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00094473 | (05) | AL |
G56244 | (02) |