Healthcare Provider Details

I. General information

NPI: 1003566282
Provider Name (Legal Business Name): FRED SHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-929-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036.175410
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: