Provider Demographics
NPI:1902843345
Name:SHUTTARI, ZAHID SYED (MD)
Entity Type:Individual
Prefix:
First Name:ZAHID
Middle Name:SYED
Last Name:SHUTTARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2100 POWELL ST STE 900
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1844
Mailing Address - Country:US
Mailing Address - Phone:510-851-7493
Mailing Address - Fax:510-851-7493
Practice Address - Street 1:149 N WEBER RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-1504
Practice Address - Country:US
Practice Address - Phone:630-456-7245
Practice Address - Fax:630-348-3074
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036114973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215059OtherBCBS PPO