Basic Information
Provider Information
NPI: 1003800954
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALSHAAR
FirstName: MAYSAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2300 N CHILDRENS PLZ
Address2: BOX 152
City: CHICAGO
State: IL
PostalCode: 606143363
CountryCode: US
TelephoneNumber: 7738806903
FaxNumber: 7738803068
Practice Location
Address1: 2300 N CHILDRENS PLZ
Address2: OUTREACH PHYSICIAN SERVICES
City: CHICAGO
State: IL
PostalCode: 606143363
CountryCode: US
TelephoneNumber: 7738806903
FaxNumber: 7738803068
Other Information
ProviderEnumerationDate: 09/07/2005
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X ILY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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