Provider Demographics
NPI:1871541110
Name:CHAUDHRY, SHAUKAT ALI (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUKAT
Middle Name:ALI
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:303 S MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2189
Mailing Address - Country:US
Mailing Address - Phone:574-255-4191
Mailing Address - Fax:574-259-8468
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2189
Practice Address - Country:US
Practice Address - Phone:574-255-4191
Practice Address - Fax:574-259-8468
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN1025631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC25549Medicare UPIN
727790Medicare PIN