Provider Demographics
NPI:1457512618
Name:SHASHIKANT, DAVID THAMMADI (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THAMMADI
Last Name:SHASHIKANT
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 1:1100 EAST WOODFIELD ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5116
Mailing Address - Country:US
Mailing Address - Phone:847-619-1401
Mailing Address - Fax:630-439-0163
Practice Address - Street 1:1112 JONATHAN DRIVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-592-7476
Practice Address - Fax:847-874-7137
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3360772112082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck