Healthcare Provider Details

I. General information

NPI: 1750415261
Provider Name (Legal Business Name): SHELLEY J. KORSHAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE SUITE 700
CHICAGO IL
60602-3402
US

IV. Provider business mailing address

30 N MICHIGAN AVE SUITE 700
CHICAGO IL
60602-3402
US

V. Phone/Fax

Practice location:
  • Phone: 312-263-3110
  • Fax: 312-263-3119
Mailing address:
  • Phone: 312-263-3110
  • Fax: 312-263-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: