Healthcare Provider Details

I. General information

NPI: 1497558027
Provider Name (Legal Business Name): SHANA KADAVIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

IV. Provider business mailing address

9555 S 52ND AVE
OAK LAWN IL
60453-3054
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-5700
  • Fax: 708-422-8225
Mailing address:
  • Phone: 708-422-5700
  • Fax: 708-422-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125085667
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: