Individual
DR. FADI MICHEL SHAMSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4115 S. WATER TOWER PLACE, MT. VERNON, IL 62864
(618) 204-5462
(618) 204-5472
Mailing address
4115 S. WATER TOWER PLACE, P.O.BOX 1003, MT. VERNON, IL 62864
(618) 204-5462
(618) 204-5472
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036123701
IL
207RC0000X
Cardiovascular Disease Physician
036123701
IL
207RI0011X
Interventional Cardiology Physician
Primary
036123701
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036123701
—
IL
Enumeration date
05/23/2005
Last updated
04/19/2010
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