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1427055433

NPI Code Detail

MEDICARE: DR. SHANE R FANCHER MD

MEDICARE: DR. SHANE R FANCHER 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	207L00000X	Anesthesiology Physician	036-094339	IL
2	208600000X	Surgery Physician	24559	SC
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	036-094339	IL
4	207L00000X	Anesthesiology Physician	24559	SC
5	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME93432	FL
6	207L00000X	Anesthesiology Physician	ME93432	FL
7	207LP2900X	Pain Medicine (Anesthesiology) Physician	24559	SC
8	208600000X	Surgery Physician	ME93432	FL
9	208VP0014X	Interventional Pain Medicine Physician	036-094339	IL
10	208600000X	Surgery Physician	036-094339	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	336055454	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427055433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE R FANCHER MD

Provider Business Mailing Address
First Line	:	4160 S LAKE CT
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-8440
Country	:	US
Telephone Number	:	217-425-9665
Fax Number	:	217-425-9664

Provider Business Practice Location Address
First Line	:	1800 E LAKE SHORE DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-3810
Country	:	US
Telephone Number	:	217-464-2729
Fax Number	:	217-464-1693

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	12/16/2025

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Directions to “ DR. SHANE R FANCHER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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