Provider Demographics
NPI:1093963563
Name:SHAMAI, LIOR (DO)
Entity Type:Individual
Prefix:
First Name:LIOR
Middle Name:
Last Name:SHAMAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4414
Mailing Address - Country:US
Mailing Address - Phone:954-684-2222
Mailing Address - Fax:
Practice Address - Street 1:2518 E 26TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-4414
Practice Address - Country:US
Practice Address - Phone:954-684-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10428207R00000X, 207RC0000X, 207RI0011X
KY03596207RC0000X, 207RI0011X
OK7452207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100251430Medicaid
IN201198750Medicaid
KY7100251430Medicaid
KYK099280Medicare PIN