Active NPI
Ismaeel Shanshal
- Dental Anesthesiology
- Chicago, IL
National Provider Identifier
1487174124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- 019.031284
- Practice address
- 811 W Wellington Ave
Chicago, IL 60657-5123 - Phone
- (773) 871-2188
- NPI assigned
- Jun 23, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Anesthesiology | 1223D0004X | 019.031284 | IL | Primary |
Addresses
Primary practice location
811 W Wellington Ave
Chicago, IL 60657-5123
Mailing address
1900 W Polk St
Chicago, IL 60612-3723
Phone (224) 500-1306
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.031284 | IL | MD | Dentist Anesthesiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718668800000",
"number": "1487174124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 W POLK ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123723",
"telephone_number": "224-500-1306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 W WELLINGTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606575123",
"telephone_number": "773-871-2188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANSHAL",
"first_name": "ISMAEEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-23",
"last_updated": "2024-06-18",
"certification_date": "2024-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "IL",
"license": "019.031284",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.