Provider Demographics
NPI:1285654228
Name:HEALY, SHAUN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:P
Last Name:HEALY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0871
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-654-4253
Practice Address - Street 1:5280 METROPOLITAN PKWY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4005
Practice Address - Country:US
Practice Address - Phone:586-446-8688
Practice Address - Fax:586-446-9994
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052855207RI0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4177780-10Medicaid
MIM73220006Medicare ID - Type Unspecified
MI4177780-10Medicaid
MIF16410Medicare UPIN