MEDICARE: DR. SHEN SONG 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	207RN0300X	Nephrology Physician	036.156218	IL
2	207RN0300X	Nephrology Physician	A150126	CA

General Provider Information

NPI Number	:	1518386911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEN SONG MD

Provider Business Mailing Address
First Line	:	120 W 22ND ST STE 200
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1563
Country	:	US
Telephone Number	:	630-573-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 W GOLF RD STE 105
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4276
Country	:	US
Telephone Number	:	847-439-8780
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	05/31/2022

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Directions to “ DR. SHEN SONG MD” Practice Location

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