Healthcare Provider Details

I. General information

NPI: 1457974818
Provider Name (Legal Business Name): MARIAN K SHAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAN SHEHATA

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

17333 LA GRANGE RD STE 220
TINLEY PARK IL
60487-7510
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 708-226-2890
  • Fax: 708-226-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036174203
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: