Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 019031574 | IL |
NPI | 1013408194 |
---|---|
Provider Name | Amer Shammaa |
First Address | Minneapolis, MN 55486-0001 |
Second Address | Downers Grove, IL 60515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2018 |
Last Update Date | 14/08/2018 |