Provider Demographics
NPI:1679600738
Name:DILLON & SHAW, MD,SC
Entity type:Organization
Organization Name:DILLON & SHAW, MD,SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-933-3956
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-933-3956
Mailing Address - Fax:847-679-1505
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-933-3956
Practice Address - Fax:847-679-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633008OtherBLUE SHIELD
IL204329Medicare ID - Type Unspecified