MEDICARE: FEINAN SHI 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036109768	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036109768	OTHER	IL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1356301667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FEINAN SHI MD

Provider Business Mailing Address
First Line	:	207 ROCKFORD AVE
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-1209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E 51ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2400
Country	:	US
Telephone Number	:	312-572-2152
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	04/30/2021

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Directions to “ FEINAN SHI MD” Practice Location

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