Provider Demographics
NPI:1003957713
Name:DAVIES, SHAWN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 W NORTH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2100
Mailing Address - Country:US
Mailing Address - Phone:630-530-1501
Mailing Address - Fax:630-530-1908
Practice Address - Street 1:533 W NORTH AVE STE 101
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2100
Practice Address - Country:US
Practice Address - Phone:630-530-1501
Practice Address - Fax:630-530-1908
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL364184220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627404OtherBCBS OF IL
IL364184220OtherTAX ID
IL036095338Medicaid
IL364184220OtherTAX ID
IL036095338Medicaid