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NPI Code Detail

MEDICARE: DR. JOSEPH SHANAHAN MD

MEDICARE:  DR. JOSEPH  SHANAHAN  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician36057774IL

General Provider Information

NPI Number : 1164471934
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH SHANAHAN MD
Provider Business Mailing Address
First Line : 911 N ELM ST
Second Line : SUITE 215
City : HINSDALE
State : IL
Zip : 60521-3634
Country : US
Telephone Number : 632-856-6865
Fax Number : 630-856-6813
Provider Business Practice Location Address
First Line : 701 WINTHROP AVE
Second Line :
City : GLENDALE HEIGHTS
State : IL
Zip : 60139-1405
Country : US
Telephone Number : 630-545-5700
Fax Number : 630-545-5784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 04/26/2013

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Directions to “ DR. JOSEPH SHANAHAN MD” Practice Location

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