Provider Demographics
NPI:1144418401
Name:SHAFIQ, OBAID (MD)
Entity type:Individual
Prefix:
First Name:OBAID
Middle Name:
Last Name:SHAFIQ
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 1:2400 N ROCKTON AVE
Mailing Address - Street 2:INTERNAL MEDICINE HOSPITALIST SVCS
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3655
Mailing Address - Country:US
Mailing Address - Phone:815-971-5000
Mailing Address - Fax:815-971-9299
Practice Address - Street 1:2400 N ROCKTON AVE
Practice Address - Street 2:INTERNAL MEDICINE HOSPITALIST SVCS
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103
Practice Address - Country:US
Practice Address - Phone:815-971-5000
Practice Address - Fax:815-971-9299
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54415207R00000X
IN01070252A207R00000X
IL036117912208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881OtherMEDICARE GROUP NUMBER
IL605710016Medicare PIN
IL214881Medicare Oscar/Certification