Individual
DR. HYTHEM P SHADID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 FOXFIELD RD, SUITE 102, ST CHARLES, IL 60174-5799
(630) 377-1188
(630) 377-7360
Mailing address
2900 FOXFIELD RD, SUITE 102, ST CHARLES, IL 60174-5799
(630) 377-1188
(630) 377-7360
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
036082388
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082388
—
IL
01
—
04525539
BCBS PROVIDER #
IL
01
—
1477567394
GROUP NPI
IL
01
—
200038958
MEDICARE RAILROAD (PTAN)
IL
01
—
364333655
TAX ID#
IL
01
—
3643336556019001
HFS PAYEE ID
IL
01
—
DO4326
GROUP PTAN
IL
Enumeration date
07/28/2006
Last updated
04/20/2012
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