Provider Demographics
NPI:1154186203
Name:VITAL MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:VITAL MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-985-1214
Mailing Address - Street 1:14489 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2671
Mailing Address - Country:US
Mailing Address - Phone:708-364-1205
Mailing Address - Fax:708-364-1265
Practice Address - Street 1:701 LEE ST STE 150
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4554
Practice Address - Country:US
Practice Address - Phone:224-985-1214
Practice Address - Fax:224-285-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care