Provider Demographics
NPI:1174965784
Name:SHIFA THERAPEUTICS LLC
Entity type:Organization
Organization Name:SHIFA THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:NOUMAN
Authorized Official - Last Name:AZHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-521-8983
Mailing Address - Street 1:1019 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2309
Mailing Address - Country:US
Mailing Address - Phone:516-521-8983
Mailing Address - Fax:
Practice Address - Street 1:1019 GROVE LN
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2309
Practice Address - Country:US
Practice Address - Phone:516-521-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361218692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty