Individual
SHIN I NAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 MAPLE ROAD, JOLIET, IL 60432-1439
(815) 723-9351
(815) 723-9823
Mailing address
1200 MAPLE ROAD, SUITE 3309, JOLIET, IL 60432-1439
(815) 723-9351
(815) 723-9823
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036052538
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052538
—
IL
05
—
36-052538
—
IL
Enumeration date
12/05/2005
Last updated
02/09/2009
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