Individual
DR. SHADY HENIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E CARPENTER ST # 62, SPRINGFIELD, IL 62769-1000
(217) 492-9115
(217) 522-1206
Mailing address
129 E REDSTONE AVE, STE A, CRESTVIEW, FL 32539-5350
(217) 492-9115
(217) 522-1206
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD15478
RI
207RI0011X
Interventional Cardiology Physician
Primary
036151656
IL
Other
Enumeration date
06/11/2013
Last updated
08/26/2021
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