Individual
ELISHEVA DOUGLAS SHANES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
710 N FAIRBANKS CT STE 2-461, CHICAGO, IL 60611
(312) 926-3212
Mailing address
710 N FAIRBANKS CT STE 2-461, CHICAGO, IL 60611-3013
(312) 926-3212
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
036146153
IL
Other
Enumeration date
06/20/2014
Last updated
10/18/2019
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