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General NPI Number Information
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NPI Number | 1225087752
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Entity Type | Individual
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Provider Name | MARK SHUKHMAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 4711 GOLF RD SUITE 1200
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City | SKOKIE
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State | IL
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Zip | 60076-1224
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Country | US
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Telephone | 847-563-4488
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Fax | 847-929-9355
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Provider Business Mailing Address
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Address Line | 4711 GOLF RD SUITE 1200
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City | SKOKIE
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State | IL
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Zip | 60076-1224
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Country | US
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Telephone | 847-563-4488
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Fax | 847-929-9355
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-103040
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 036-103040
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036-103040
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 36-103040
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License Number State | IL
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