Provider Demographics
NPI:1922150010
Name:TENHOUSE, SHAWN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:TENHOUSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 TWO PATHS DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4512
Mailing Address - Country:US
Mailing Address - Phone:630-202-1552
Mailing Address - Fax:
Practice Address - Street 1:2975 TWO PATHS DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4512
Practice Address - Country:US
Practice Address - Phone:630-202-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4082213EP1101X
IL016004682213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004682Medicaid
IL0006606203OtherBLUE CROSS
IL0006606203OtherBLUE CROSS
IL016004682Medicaid