Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 036147260 | IL |
NPI | 1184816829 |
---|---|
Provider Name | Dr. Shuja Ahmed |
First Address | Springfield, IL 62703-2403 |
Second Address | Springfield, IL 62701-1041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 19/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5921364 | (05) | NC |