Provider Demographics
NPI:1851311450
Name:SHOWNKEEN, HARISH N (MD)
Entity Type:Individual
Prefix:
First Name:HARISH
Middle Name:N
Last Name:SHOWNKEEN
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 1:25 N WINFIELD ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-2113
Mailing Address - Fax:630-933-4520
Practice Address - Street 1:25 N WINFIELD ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-2113
Practice Address - Fax:630-933-4520
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360904102085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090410Medicaid
ILK14784OtherMEDICARE PTAN (INDIVIDUAL)
IL036090410Medicaid
ILG18633Medicare UPIN
IL206147Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER