Provider Demographics
NPI:1023032646
Name:SHAHBAIN, ABDUL-HAMID MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL-HAMID
Middle Name:MOHAMMED
Last Name:SHAHBAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 S HARLEM AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1597
Mailing Address - Country:US
Mailing Address - Phone:708-671-1685
Mailing Address - Fax:708-671-1695
Practice Address - Street 1:12508 S HARLEM AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1597
Practice Address - Country:US
Practice Address - Phone:708-671-1685
Practice Address - Fax:708-671-1695
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633951OtherBCBS
IL036085113Medicaid
ILK03889Medicare PIN
IL01633951OtherBCBS