MEDICARE: SHAHER FAMILY HEALTH CENTER LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336444991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHER FAMILY HEALTH CENTER LTD

Provider Business Mailing Address
First Line	:	2906 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3813
Country	:	US
Telephone Number	:	708-299-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3813
Country	:	US
Telephone Number	:	708-299-3524
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AHMED SHAHER
Credential	:
Telephone Number	:	708-299-3524

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	04/13/2011

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