Provider Demographics
NPI:1518122035
Name:TEKWANI, SHIVAN HIRALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVAN
Middle Name:HIRALAL
Last Name:TEKWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 WAVERLY CT
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-1880
Mailing Address - Country:US
Mailing Address - Phone:312-371-2510
Mailing Address - Fax:
Practice Address - Street 1:2640 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2914
Practice Address - Country:US
Practice Address - Phone:708-798-6633
Practice Address - Fax:708-798-6790
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.255051207W00000X
IL125.051255207W00000X
IL036.127859207W00000X
KY43666207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology