Provider Demographics
NPI:1336168848
Name:ALSHAMI, EMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:
Last Name:ALSHAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 SUMMITT DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3400
Mailing Address - Country:US
Mailing Address - Phone:513-423-4546
Mailing Address - Fax:513-423-4548
Practice Address - Street 1:1060 SUMMIT DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042
Practice Address - Country:US
Practice Address - Phone:513-423-4546
Practice Address - Fax:513-423-4548
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0846292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000337326OtherANTHEM ID#
OH4136191OtherMEDICARE ID
OHP001381BOtherRAILROAD MEDICARE #
OH201167053OtherTAX ID#
OH201167053-00OtherBWC
OH2504221Medicaid
OH201167053OtherTAX ID#