Provider Demographics
NPI:1669649158
Name:NHO, SHANE JAY (MD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:JAY
Last Name:NHO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:#240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:708-236-2673
Mailing Address - Fax:708-492-5673
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:STE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-243-4244
Practice Address - Fax:312-942-1517
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2022-12-12
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Provider Licenses
StateLicense IDTaxonomies
IL036-120601207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL# 1633878OtherBCBS
IL# 1633878OtherBCBS
ILR02215-#207073Medicare PIN