Provider Demographics
NPI:1740773928
Name:SHEPHERD, EMILY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANNE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11516 183RD PL STE SW
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9471
Mailing Address - Country:US
Mailing Address - Phone:708-877-1300
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 915
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-5590
Practice Address - Country:US
Practice Address - Phone:312-942-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036159771207W00000X
IL036.159771207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036159771Medicaid