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NPI Code Detail

MEDICARE: FNU SHIVANI

MEDICARE: FNU SHIVANI
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
1207R00000XInternal Medicine Physician036179086IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1366130411
Entity Type Code : Individual
Provider Name (Legal Business Name) : FNU SHIVANI
Provider Business Mailing Address
First Line : 2900 N LAKE SHORE DR # A
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5640
Country : US
Telephone Number : 773-665-3017
Fax Number :
Provider Business Practice Location Address
First Line : 2900 N LAKE SHORE DR # A
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5640
Country : US
Telephone Number : 773-665-3017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2023
Last Update Date : 04/15/2026

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Directions to “ FNU SHIVANI ” Practice Location

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