Healthcare Provider Details

I. General information

NPI: 1447955646
Provider Name (Legal Business Name): SHATHA HUSSAIN ALSAMAWI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 DAKOTA LN
ORLAND PARK IL
60462-1887
US

IV. Provider business mailing address

7810 DAKOTA LN
ORLAND PARK IL
60462-1887
US

V. Phone/Fax

Practice location:
  • Phone: 708-963-2239
  • Fax:
Mailing address:
  • Phone: 708-963-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036180978
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: