Individual
NICHOLAS JOSEPH SHEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2045 W GRAND AVE STE B, PMB 82557, CHICAGO, IL 60612-1577
(312) 268-4070
(312) 277-1042
Mailing address
2045 W GRAND AVE STE B, CHICAGO, IL 60612-1577
(312) 268-4070
(312) 277-1042
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036123263
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036123263
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147027
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
08/22/2008
Last updated
04/09/2021
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