Provider Demographics
NPI:1144208125
Name:SHANKS, ERIN L (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:SHANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W 75TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-355-0003
Mailing Address - Fax:630-355-9822
Practice Address - Street 1:1331 W 75TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-355-0003
Practice Address - Fax:630-355-9822
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101700Medicaid