MEDICARE: DR. MICHAEL BRYAN SHANE M.D.

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
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	125054305	IL
2	207L00000X	Anesthesiology Physician	036127547	IL

General Provider Information

NPI Number	:	1225284888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRYAN SHANE M.D.

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4028
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6700
Fax Number	:	773-702-3535

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4028
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6700
Fax Number	:	773-702-3535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	04/20/2026

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