Provider Demographics
NPI:1699208348
Name:PHILANDER, SHANNON ALISON EILEENE (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ALISON EILEENE
Last Name:PHILANDER
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 1:1333 W BELMONT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5785
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:773-248-3001
Practice Address - Street 1:1333 W BELMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5785
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:773-248-3001
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036153605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine