Healthcare Provider Details

I. General information

NPI: 1699351007
Provider Name (Legal Business Name): SHEEMA SHABAHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 W WILSON AVE FL 4
CHICAGO IL
60640-5257
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9330
  • Fax: 773-296-7768
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036.170928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: