Provider Demographics
NPI:1104117423
Name:SHIRAZI, ABDUL (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:SHIRAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 STATE ROUTE 91 STE 250
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7831
Mailing Address - Country:US
Mailing Address - Phone:309-692-5393
Mailing Address - Fax:309-692-2538
Practice Address - Street 1:8600 STATE ROUTE 91 STE 250
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7831
Practice Address - Country:US
Practice Address - Phone:309-692-5393
Practice Address - Fax:309-692-2538
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60592207L00000X
IL036-138223207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036138223OtherSTATE LICENSE