Healthcare Provider Details

I. General information

NPI: 1801060421
Provider Name (Legal Business Name): MARSHALL SHIKAMI DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 S HALSTED ST
CHICAGO HEIGHTS IL
60411-3523
US

IV. Provider business mailing address

1526 S HALSTED ST
CHICAGO HEIGHTS IL
60411-3523
US

V. Phone/Fax

Practice location:
  • Phone: 708-754-1063
  • Fax: 708-755-4696
Mailing address:
  • Phone: 708-754-1063
  • Fax: 708-755-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019018895
License Number StateIL

VIII. Authorized Official

Name: DR. MARSHALL J SHIKAMI
Title or Position: PRESIDENT
Credential: DDS
Phone: 708-754-1063