Provider Demographics
NPI:1851457717
Name:SHLYAK, JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:SHLYAK
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 1:3000 DUNDEE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2432
Mailing Address - Country:US
Mailing Address - Phone:847-390-8550
Mailing Address - Fax:847-390-9095
Practice Address - Street 1:3000 DUNDEE RD STE 215
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2432
Practice Address - Country:US
Practice Address - Phone:847-390-8550
Practice Address - Fax:847-390-9095
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064733Medicaid
IL31620794OtherBLUE CROSS BLUE SHIELD
IL036064733Medicaid
ILD15305Medicare UPIN