Healthcare Provider Details

I. General information

NPI: 1801014675
Provider Name (Legal Business Name): TANVEER Y SHAMSI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

402 66TH ST
DOWNERS GROVE IL
60516-3001
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-1500
  • Fax: 312-864-9222
Mailing address:
  • Phone: 630-512-0993
  • Fax: 630-512-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: