Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 364184220 | IL |
NPI | 1003957713 |
---|---|
Provider Name | Dr. Shawn Michael Davies |
First Address | Elmhurst, IL 60126-2100 |
Second Address | Elmhurst, IL 60126-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036095338 | (05) | IL |
1627404 | BCBS OF IL (01) | IL |
364184220 | TAX ID (01) | IL |
G84469 | (02) | IL |