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General NPI Number Information
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NPI Number | 1851457717
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Entity Type | Individual
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Provider Name | JEAN SHLYAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 3000 DUNDEE RD STE 215
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City | NORTHBROOK
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State | IL
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Zip | 60062-2432
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Country | US
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Telephone | 847-390-8550
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Fax | 847-390-9095
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Provider Business Mailing Address
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Address Line | 3000 DUNDEE RD STE 215
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City | NORTHBROOK
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State | IL
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Zip | 60062-2432
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Country | US
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Telephone | 847-390-8550
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Fax | 847-390-9095
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036064733
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License Number State | IL
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