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General NPI Number Information
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NPI Number | 1962411793
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Entity Type | Individual
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Provider Name | SHISHIN YAMADA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 1890 SILVER CROSS BLVD PAVILION A, SUITE 560
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City | NEW LENOX
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State | IL
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Zip | 60451-9583
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Country | US
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Telephone | 815-714-9362
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Fax | 815-846-1777
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Provider Business Mailing Address
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Address Line | 1890 SILVER CROSS BLVD STE 550
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City | NEW LENOX
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State | IL
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Zip | 60451-9579
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Country | US
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Telephone | 815-714-9362
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Fax | 815-846-1777
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036112458
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License Number State | IL
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