Provider Demographics
NPI:1336444991
Name:SHAHER FAMILY HEALTH CENTER LTD
Entity Type:Organization
Organization Name:SHAHER FAMILY HEALTH CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-299-3524
Mailing Address - Street 1:2906 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3813
Mailing Address - Country:US
Mailing Address - Phone:708-299-3524
Mailing Address - Fax:
Practice Address - Street 1:2906 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3813
Practice Address - Country:US
Practice Address - Phone:708-299-3524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114223Medicaid