Individual
DR. SHANE R FANCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-2729
(217) 464-1693
Mailing address
4160 S LAKE CT, DECATUR, IL 62521-8440
(217) 425-9665
(217) 425-9664
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036-094339
IL
207L00000X
Anesthesiology Physician
24559
SC
207L00000X
Anesthesiology Physician
ME93432
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036-094339
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
24559
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
ME93432
FL
208600000X
Surgery Physician
036-094339
IL
208600000X
Surgery Physician
24559
SC
208600000X
Surgery Physician
ME93432
FL
208VP0014X
Interventional Pain Medicine Physician
036-094339
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036094339
—
IL
01
—
336055454
BCBS
IL
Enumeration date
07/05/2005
Last updated
12/16/2025
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