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General NPI Number Information
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NPI Number | 1740236835
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Entity Type | Individual
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Provider Name | JEFFREY SHANES M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 675 W NORTH AVE SUITE-210
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City | MELROSE PARK
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State | IL
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Zip | 60160-1634
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Country | US
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Telephone | 708-838-1448
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Fax | 708-344-0508
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Provider Business Mailing Address
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Address Line | 675 W NORTH AVE SUITE-210
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City | MELROSE PARK
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State | IL
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Zip | 60160-1634
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Country | US
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Telephone | 708-838-1448
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Fax | 708-344-0508
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 036-064782
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036-064782
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License Number State | IL
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