Provider Demographics
NPI:1225047921
Name:ALSHAHROUR, ADEEB (MD)
Entity Type:Individual
Prefix:
First Name:ADEEB
Middle Name:
Last Name:ALSHAHROUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ADEEB
Other - Middle Name:
Other - Last Name:ALSHAHROUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4009 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2103
Mailing Address - Country:US
Mailing Address - Phone:630-415-6996
Mailing Address - Fax:888-289-5746
Practice Address - Street 1:4009 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2103
Practice Address - Country:US
Practice Address - Phone:773-661-9049
Practice Address - Fax:888-289-5746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112499207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-112499Medicaid
I71101Medicare UPIN