Doctor Name: | DR. SHAHAB MOHIUDDIN |
NPI Number: | 1255568853 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 472 North Route 47 Sugar Grove, IL - 60554 |
Business Phone Number: | 6306925244 |
Business Fax Number: | 6304666001 |
Mailing Address: | 2040 Ogden Ave, Suite 313 AURORA |
State: | IL |
Postal Code: | 605047206 |
Phone Number: | 6304992404 |
Fax Number: | 6304992399 |
NPI Enumeration Date: | 06/22/2009 |
NPI Last Update Date: | 11/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |