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General NPI Number Information
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NPI Number | 1184857500
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Entity Type | Individual
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Provider Name | SEGUN SADIQUE SHONIBARE CRNA, MS
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Gender | Male
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 1325 N HIGHLAND AVE ANESTHESIA DEPT
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City | AURORA
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State | IL
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Zip | 60506-1449
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Country | US
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Telephone | 630-859-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E 33RD ST APT# 2005
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City | CHICAGO
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State | IL
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Zip | 60616-4055
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Country | US
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Telephone | 773-263-4812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209007761
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License Number State | IL
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