Provider Demographics
NPI:1184740524
Name:SHAW, ELEANOR M (MD)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4969 BENCHMARK CENTRE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8928
Mailing Address - Country:US
Mailing Address - Phone:618-235-2311
Mailing Address - Fax:618-589-3335
Practice Address - Street 1:4969 BENCHMARK CENTRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8928
Practice Address - Country:US
Practice Address - Phone:618-235-2311
Practice Address - Fax:618-589-3335
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2014-10-03
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Provider Licenses
StateLicense IDTaxonomies
IL036081980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics