Provider Demographics
NPI:1598845695
Name:EWING, SHANNON M (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:EWING
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1644
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:9977 WOODS DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:847-663-8060
Practice Address - Fax:847-663-1027
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH40597Medicare UPIN