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Individual

AHMED SHARIF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
305 W JACKSON ST, CARBONDALE, IL 62901-1474
(618) 536-6621
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 549-0721
(618) 529-0479

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036149433
IL
207Q00000X
Family Medicine Physician
125068327
IL
208M00000X
Hospitalist Physician
Primary
036149433
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
214881
MULTI SPECIALTY GROUP PTAN
IL
Enumeration date
06/19/2016
Last updated
06/15/2021
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