Basic Information
| Provider Information | |||||||||
| NPI: | 1679600738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DILLON & SHAW, MD,SC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPREHENSIVE HEALTHCARE FOR WOMEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9669 KENTON AVE | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479333956 | ||||||||
| FaxNumber: | 8476791505 | ||||||||
| Practice Location | |||||||||
| Address1: | 9669 KENTON AVE | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479333956 | ||||||||
| FaxNumber: | 8476791505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8479333956 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01633008 | 01 | IL | BLUE SHIELD | OTHER |