Basic Information
| Provider Information | |||||||||
| NPI: | 1083811418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOWDHRY | ||||||||
| FirstName: | SHAKEEL | ||||||||
| MiddleName: | AHMAD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE | ||||||||
| Address2: | DEPARTMENT OF NEUROSURGERY | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475704224 | ||||||||
| FaxNumber: | 8475701442 | ||||||||
| Practice Location | |||||||||
| Address1: | 2180 PFINGSTEN RD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701440 | ||||||||
| FaxNumber: | 8475701442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 45793 | AZ | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 036133570 | IL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036133570 | 01 | IL | STATE LICENSE | OTHER |