Healthcare Provider Details

I. General information

NPI: 1679276745
Provider Name (Legal Business Name): HUMA SHAMIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3591 GRIFFIN AVE
PEKIN IL
61554-6258
US

IV. Provider business mailing address

3591 GRIFFIN AVE
PEKIN IL
61554-6258
US

V. Phone/Fax

Practice location:
  • Phone: 309-353-6301
  • Fax: 309-353-1884
Mailing address:
  • Phone: 309-353-6301
  • Fax: 309-353-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036179071
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: