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Individual

SHAHNAZ AHMAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3165 MYRTLE AVE, STE 2, GRANITE CITY, IL 62040-5012
(618) 876-7500
(618) 876-0807
Mailing address
3165 MYRTLE AVE, STE 2, GRANITE CITY, IL 62040-5012
(618) 876-7500
(618) 876-0807

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036061727
IL
208000000X
Pediatrics Physician
R1A07
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036061727
IL
Enumeration date
08/08/2006
Last updated
01/26/2015
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