Individual
DR. SHAFIQUE AHMAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3165 MYRTLE AVE, SUITE 2, GRANITE CITY, IL 62040-5012
(618) 876-7500
(618) 876-0807
Mailing address
3165 MYRTLE AVE, SUITE 2, GRANITE CITY, IL 62040-5012
(618) 876-7500
(618) 876-0807
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036048376
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048376
—
IL
Enumeration date
10/06/2006
Last updated
01/26/2015
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