MEDICARE: DR. SHANE PATRICK DORSEY 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
1	2084N0400X	Neurology Physician	86703	WI
2	2084N0400X	Neurology Physician	036169444	IL

General Provider Information

NPI Number	:	1346700903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE PATRICK DORSEY MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE G155
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2570
Fax Number	:	847-733-5224

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE STE G155
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2570
Fax Number	:	847-733-5224

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	01/14/2026

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