Healthcare Provider Details

I. General information

NPI: 1518122035
Provider Name (Legal Business Name): SHIVAN HIRALAL TEKWANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 183RD ST
HOMEWOOD IL
60430-2914
US

IV. Provider business mailing address

263 WAVERLY CT
WILLOWBROOK IL
60527-1880
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-6633
  • Fax: 708-798-6790
Mailing address:
  • Phone: 312-371-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125.255051
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125.051255
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.127859
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number43666
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: