Provider Demographics
NPI:1568453876
Name:SHAMS, EHAB M (MD)
Entity Type:Individual
Prefix:
First Name:EHAB
Middle Name:M
Last Name:SHAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7447 W. TALCOTT AVE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-774-1790
Mailing Address - Fax:773-774-1796
Practice Address - Street 1:7447 W. TALCOTT AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-774-1790
Practice Address - Fax:773-774-1796
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036094256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094256Medicaid
IL036094256Medicaid
IL539180Medicare ID - Type Unspecified