Healthcare Provider Details

I. General information

NPI: 1154186203
Provider Name (Legal Business Name): VITAL MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LEE ST STE 150
DES PLAINES IL
60016-4554
US

IV. Provider business mailing address

701 LEE ST # S150
DES PLAINES IL
60016-4539
US

V. Phone/Fax

Practice location:
  • Phone: 224-985-1214
  • Fax: 224-285-1214
Mailing address:
  • Phone: 224-985-1214
  • Fax: 224-355-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AHSIN SHAMSI
Title or Position: ADMIN
Credential:
Phone: 224-985-1214