Provider Demographics
NPI:1508810037
Name:NOURBASH, SHANNON K (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:K
Last Name:NOURBASH
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 1:2500 W HIGGINS RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-5220
Mailing Address - Country:US
Mailing Address - Phone:847-839-0400
Mailing Address - Fax:847-839-0800
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 440
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-5220
Practice Address - Country:US
Practice Address - Phone:847-839-0400
Practice Address - Fax:847-839-0800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH51326Medicare UPIN