Healthcare Provider Details

I. General information

NPI: 1699208348
Provider Name (Legal Business Name): SHANNON ALISON EILEENE PHILANDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W BELMONT AVE STE 200
CHICAGO IL
60657-5785
US

IV. Provider business mailing address

1333 W BELMONT AVE STE 200
CHICAGO IL
60657-5785
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax: 773-248-3001
Mailing address:
  • Phone: 312-926-3627
  • Fax: 773-248-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036153605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: