Healthcare Provider Details

I. General information

NPI: 1538666003
Provider Name (Legal Business Name): ANDREW SHAJARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E MAIN ST
OLNEY IL
62450-2163
US

IV. Provider business mailing address

605 E MAIN ST
OLNEY IL
62450-2163
US

V. Phone/Fax

Practice location:
  • Phone: 618-395-7340
  • Fax:
Mailing address:
  • Phone: 618-395-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036166509
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: