Individual
DR. SHAWN ASHLEY KACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1675 DEMPSTER ST FL 3, PARK RIDGE, IL 60068-1110
(847) 318-9330
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125070942
IL
2084N0400X
Neurology Physician
Primary
036-159149
IL
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
036159149
IL
Other
Enumeration date
06/07/2017
Last updated
08/21/2024
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