Provider Demographics
NPI:1790164002
Name:GOLAN, SHAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAY
Middle Name:
Last Name:GOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE MC6038
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-6760
Mailing Address - Fax:773-702-1001
Practice Address - Street 1:5841 S MARYLAND AVE MC6038
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-6760
Practice Address - Fax:773-702-1001
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125066106208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology