Individual
JOHN JAY SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 W POLK ST, SUITE 220, CHICAGO, IL 60612-3723
(312) 864-5504
(312) 864-9994
Mailing address
1900 W POLK ST, SUITE 220, CHICAGO, IL 60612-3723
(312) 864-5504
(312) 864-9994
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036079704
IL
207R00000X
Internal Medicine Physician
H2772
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036079704
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
H2772
TX
207RP1001X
Pulmonary Disease Physician
036079704
IL
207RP1001X
Pulmonary Disease Physician
H2772
TX
Other
Enumeration date
07/18/2006
Last updated
03/03/2017
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