Provider Demographics
NPI:1841589843
Name:SHOENER, JALENE ANNE (MD)
Entity type:Individual
Prefix:
First Name:JALENE
Middle Name:ANNE
Last Name:SHOENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JALENE
Other - Middle Name:ANNE
Other - Last Name:LANTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:M/C 856
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-4185
Mailing Address - Fax:312-355-5548
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-996-4150
Practice Address - Fax:312-996-2328
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134281207R00000X, 208000000X
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics