Provider Demographics
NPI:1174574396
Name:KASHOW, IYAD A (MD)
Entity type:Individual
Prefix:DR
First Name:IYAD
Middle Name:A
Last Name:KASHOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IYAD
Other - Middle Name:A
Other - Last Name:KASHOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD LTD
Mailing Address - Street 1:710 SHORELINE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6192
Mailing Address - Country:US
Mailing Address - Phone:630-692-1280
Mailing Address - Fax:630-692-1284
Practice Address - Street 1:710 SHORELINE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6192
Practice Address - Country:US
Practice Address - Phone:630-692-1280
Practice Address - Fax:630-692-1284
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336047430OtherCONTROLLED SUBSTANCE
IL036085249Medicaid
IL211055OtherMEDICARE PTAN
IL036085249OtherPHYSICIAN
IL036085249OtherPHYSICIAN
ILBK7447332OtherDEA