Provider Demographics
NPI:1669047460
Name:SHEWMAKE, ALLISON K
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:K
Last Name:SHEWMAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 S BRAINARD AVE APT 421
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3020
Mailing Address - Country:US
Mailing Address - Phone:630-660-3992
Mailing Address - Fax:
Practice Address - Street 1:6700 S BRAINARD AVE APT 421
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3020
Practice Address - Country:US
Practice Address - Phone:630-660-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine