Provider Demographics
NPI:1477765097
Name:DAVID B. SHANKER, M.D.
Entity Type:Organization
Organization Name:DAVID B. SHANKER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:SHANKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-372-0150
Mailing Address - Street 1:25 E WASHINGTON ST STE 1131
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-372-0150
Mailing Address - Fax:312-372-4249
Practice Address - Street 1:25 E WASHINGTON ST STE 1131
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-372-0150
Practice Address - Fax:312-372-4249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID B. SHANKER, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-04
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209446Medicare ID - Type Unspecified