Provider Demographics
NPI:1982602892
Name:SHALASH, AMAEL ABDEL (MD)
Entity Type:Individual
Prefix:
First Name:AMAEL
Middle Name:ABDEL
Last Name:SHALASH
Suffix:
Gender:F
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:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:
Practice Address - Street 1:4 PHYSICIANS PARK
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4181
Practice Address - Country:US
Practice Address - Phone:502-223-8400
Practice Address - Fax:502-875-3073
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1982602892OtherHUMANA- NCMA FRANKFORT
IN300050569Medicaid
KY64331374Medicaid
KYK042481OtherMEDICARE
KY693104Medicare PIN
KY64331374Medicaid