Provider Demographics
NPI:1619402443
Name:MOUSA, SHIMAA (DO)
Entity Type:Individual
Prefix:
First Name:SHIMAA
Middle Name:
Last Name:MOUSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DELNOR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4229
Mailing Address - Country:US
Mailing Address - Phone:630-938-9900
Mailing Address - Fax:630-938-9930
Practice Address - Street 1:351 DELNOR DR STE 100
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4229
Practice Address - Country:US
Practice Address - Phone:630-938-9900
Practice Address - Fax:630-938-9930
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036153876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine