Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016004635 | IL |
Y | 222Z00000X | Podiatrist | 016004635 | IL |
NPI | 1043211386 |
---|---|
Provider Name | Maureen T Mcshane |
First Address | Palos Heights, IL 60463-1256 |
Second Address | Orland Park, IL 60462-4600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 06/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016004635 | (05) | IL |
U47954 | (02) |