Healthcare Provider Details

I. General information

NPI: 1710398474
Provider Name (Legal Business Name): ANDREW SHABILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 07/21/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR STE B70
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

1128 WASHINGTON BLVD APT 3A
OAK PARK IL
60302-3642
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-2661
  • Fax:
Mailing address:
  • Phone: 773-987-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number036143613
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number55269
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036143613
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: