Provider Demographics
NPI:1558750026
Name:SHANNAHAN, ANNA BALABANOVA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:BALABANOVA
Last Name:SHANNAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1475 E BELVIDERE RD
Mailing Address - Street 2:SUITE 385
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2012
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:312-694-0655
Practice Address - Street 1:150 E HURON ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2948
Practice Address - Country:US
Practice Address - Phone:312-926-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.114607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine