Provider Demographics
NPI:1083812465
Name:SHANCHUK, YELENA
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:SHANCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 BARRINGTON RD
Mailing Address - Street 2:SUITE 410 BLDG ONE
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1019
Mailing Address - Country:US
Mailing Address - Phone:847-885-3500
Mailing Address - Fax:847-686-0070
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:SUITE 410 BLDG ONE
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-885-3500
Practice Address - Fax:847-686-0070
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILFS0341901OtherDEA