Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036-090086 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036090086 | IL |
NPI | 1508899311 |
---|---|
Provider Name | Abraham Shashoua |
First Address | Chicago, IL 60674-2368 |
Second Address | Chicago, IL 60657-5188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 02/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036090086 | (05) | IL |
G34409 | (02) |