MEDICARE: JEAN SHLYAK MD PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1235431305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEAN SHLYAK MD PC

Provider Business Mailing Address
First Line	:	3492 MILWAUKEE AVE
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7128
Country	:	US
Telephone Number	:	847-390-8550
Fax Number	:	847-390-9095

Provider Business Practice Location Address
First Line	:	3492 MILWAUKEE AVE
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7128
Country	:	US
Telephone Number	:	847-390-8550
Fax Number	:	847-390-9095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEAN SHLYAK
Credential	:	M.D.
Telephone Number	:	847-390-8550

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	11/23/2010

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