=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225786882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. FERAS SHAWISH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2022
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 W WEAVER RD
-----------------------------------------------------
City | FORSYTH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62535-9762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-876-5600
-----------------------------------------------------
Fax | 217-876-5664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 241 W WEAVER RD
-----------------------------------------------------
City | FORSYTH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62535-9762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-876-5600
-----------------------------------------------------
Fax | 217-876-5664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036173631
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------