Healthcare Provider Details

I. General information

NPI: 1164558821
Provider Name (Legal Business Name): SHAMS SHAFIEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAMS SHAFIEI MD

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 S.CICERO AV OAK FOREST HOSPITAL
OAK FOREST IL
60452
US

IV. Provider business mailing address

8040 REVELL CT
ORLAND PARK IL
60462-6100
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-7200
  • Fax: 708-687-7979
Mailing address:
  • Phone: 708-873-1471
  • Fax: 708-873-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: