Healthcare Provider Details

I. General information

NPI: 1912945692
Provider Name (Legal Business Name): MEGAN MARIE SHANKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 3900
SKOKIE IL
60076
US

IV. Provider business mailing address

9650 GROSS POINT RD STE 3900
SKOKIE IL
60076-5085
US

V. Phone/Fax

Practice location:
  • Phone: 847-357-2570
  • Fax: 847-933-3520
Mailing address:
  • Phone: 847-570-2570
  • Fax: 847-933-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036098061
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: