Provider Demographics
NPI:1609194034
Name:SHAMOUN, MARLENE AMER (DPT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:AMER
Last Name:SHAMOUN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:AMER
Other - Last Name:JAJOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1501 N MILFORD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1006
Practice Address - Country:US
Practice Address - Phone:248-676-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211109Medicare PIN