Individual
KIMBERLY DANIELLE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
(708) 596-5518
Mailing address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
(708) 596-5518
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-003355
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01616617
BCBS
IL
05
—
085003355
—
IL
Enumeration date
11/14/2008
Last updated
07/18/2024
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