MEDICARE: ILAN SHAHAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	TGC110359	IL

General Provider Information

NPI Number	:	1124850896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILAN SHAHAR

Provider Business Mailing Address
First Line	:	2369 CHECKER RD
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-5133
Country	:	US
Telephone Number	:	847-769-4441
Fax Number	:

Provider Business Practice Location Address
First Line	:	2369 CHECKER RD
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-5133
Country	:	US
Telephone Number	:	847-769-4441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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Directions to “ ILAN SHAHAR ” Practice Location

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