Healthcare Provider Details

I. General information

NPI: 1346055365
Provider Name (Legal Business Name): EXCLUSIVE PHYSICIANS - ILLINOIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N CICERO AVE
CHICAGO IL
60641-5106
US

IV. Provider business mailing address

18000 W 9 MILE RD STE 200
SOUTHFIELD MI
48075-4020
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NILLIAN SHAOUNI
Title or Position: RCM
Credential:
Phone: 248-336-4000