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NPI Code Detail

MEDICARE: MR. MOTAZ SAMIH MUSTAFA ALSHAMI MD

MEDICARE: MR. MOTAZ SAMIH MUSTAFA ALSHAMI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician036.159979IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1336636398
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MOTAZ SAMIH MUSTAFA ALSHAMI MD
Provider Business Mailing Address
First Line : 5159 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-4931
Country : US
Telephone Number : 773-434-9216
Fax Number : 773-434-2670
Provider Business Practice Location Address
First Line : 5159 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-4931
Country : US
Telephone Number : 773-434-9216
Fax Number : 773-434-2670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2018
Last Update Date : 09/02/2025

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