Provider Demographics
NPI:1053599233
Name:SHAMSI, OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:SHAMSI
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 1:1200 S YORK ST
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5626
Mailing Address - Country:US
Mailing Address - Phone:331-221-6140
Mailing Address - Fax:331-221-3838
Practice Address - Street 1:1200 S YORK ST
Practice Address - Street 2:SUITE 1240
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:331-221-6140
Practice Address - Fax:331-221-3838
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125176207R00000X, 207RB0002X, 207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01066903AOtherINDIANA PROFESSIONAL LICENSING AGENCY MEDICAL LICENSING BOARD
IN200967190AMedicaid
IN200967190AMedicaid