Provider Demographics
NPI:1487955878
Name:SHIFA NEPHROLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:SHIFA NEPHROLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF THE LLC
Authorized Official - Prefix:
Authorized Official - First Name:MAZHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH-KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-423-6400
Mailing Address - Street 1:6316 N LINCOLN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1204
Mailing Address - Country:US
Mailing Address - Phone:773-423-6400
Mailing Address - Fax:773-583-6301
Practice Address - Street 1:6316 N LINCOLN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1204
Practice Address - Country:US
Practice Address - Phone:773-423-6400
Practice Address - Fax:773-583-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDS5935Medicare PIN
ILIL4949Medicare PIN