Organization
BRIAN J SHAHEEN MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN J SHAHEEN MD (PRESIDENT)
(618) 244-2296
Entity
Organization
Contact information
Practice address
1104 S 42ND STREET, MOUNT VERNON, IL 62864-6216
(618) 244-2296
(618) 244-0074
Mailing address
4227 LINCOLSHIRE DRIVE, MOUNT VERNON, IL 62864-2157
(618) 242-2317
(618) 242-9710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
704010
MEDICARE
—
Enumeration date
11/22/2006
Last updated
08/22/2020
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