Individual
DR. EJAZ SHAMIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9224 NAGLE AVE, MORTON GROVE, IL 60053-1428
(847) 966-7917
Mailing address
9224 NAGLE AVE, MORTON GROVE, IL 60053-1428
(847) 966-7917
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01057985A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
036.104277
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200451430
—
IN
01
—
P00086529
RR MEDICARE
IN
Enumeration date
11/03/2005
Last updated
01/22/2014
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