Provider Demographics
NPI:1164558821
Name:SHAFIEI, SHAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMS
Middle Name:
Last Name:SHAFIEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAMS
Other - Middle Name:
Other - Last Name:SHAFIEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8040 REVELL CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6100
Mailing Address - Country:US
Mailing Address - Phone:708-873-1471
Mailing Address - Fax:708-873-1516
Practice Address - Street 1:15900 S.CICERO AV
Practice Address - Street 2:OAK FOREST HOSPITAL
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-687-7200
Practice Address - Fax:708-687-7979
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist