Healthcare Provider Details

I. General information

NPI: 1023713153
Provider Name (Legal Business Name): HANY SHAHIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17019 HARLEM AVE
TINLEY PARK IL
60477-2739
US

IV. Provider business mailing address

7930 W 103RD ST
PALOS HILLS IL
60465-1567
US

V. Phone/Fax

Practice location:
  • Phone: 708-532-3233
  • Fax:
Mailing address:
  • Phone: 708-663-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016006167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: