JUSTIN LEE SHANK (NPI# 1598280463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598280463 |
| Entity Type | Individual |
| Full Name | JUSTIN LEE SHANK |
| Credential | PA-C |
| Practice Address |
17800 Kedzie Ave Hazel Crest IL 60429-2029 |
| Mailing Address |
1519 W Nelson St # Fb2 Chicago IL 60657-9358 |
| Practice Telephone | 7087998000 |
| Mailing Telephone | 2102893099 |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085006303 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9550 W 167th St, Orland Park, IL 604675561 | 7088734500 |
| Street Address |
17800 KEDZIE AVE |
| City | HAZEL CREST |
| State | IL |
| Zip Code | 60429-2029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932189206 | Emad Foroohar | Emergency Medicine | 17800 Kedzie Ave, Emergency Department, Hazel Crest, IL 60429-2029 | 2006-01-20 |
| 1396357216 | Katelyn Nicole Konow | Physical Therapist | 17800 Kedzie Ave, Hazel Crest, IL 60429-0989 | 2020-08-21 |
| 1275143539 | Lisa Marie Tomaszewski | Nurse Practitioner | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2020-08-03 |
| 1275151623 | Mallory Clare Storrs | Dietitian, Registered | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2020-07-13 |
| 1750904405 | Mark Daniel Fralix II | Physical Therapist | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2020-05-28 |
| 1699309948 | Monique Montgomery | Physical Therapist | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2020-02-25 |
| 1215567599 | Rasaq Durojaiye | Nurse Practitioner | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2020-01-25 |
| 1124664693 | Lara Eiler | Physical Therapist | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2019-11-20 |
| 1710521349 | Tamara Lynn Powers | Physical Therapist | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2019-11-06 |
| 1235789710 | Abolade Jamiu Olawale | Surgery | 17800 Kedzie Ave, Hazel Crest, IL 60429-2029 | 2019-09-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659917987 | Nancy Sinwelski | Technician | 17305 Fisk Street, East Hazelcrest, IL 60429 | 2019-11-21 |
| 1144720871 | Plentiful Hair Studio LLC | Specialist | 17504 E Carriageway Dr Ste D, Hazel Crest, IL 60429 | 2018-02-19 |
| 1376052142 | Natalie Allen | Counselor | 3518 Birchwood Dr, Hazel Crest, IL 60429 | 2017-09-25 |
| 1730534009 | Lydena Franklin | Counselor | 1909 Cheker Square, East Hazel Crest, IL 60429 | 2016-04-25 |
| 1710331053 | Lauiren Orta | Counselor | 1901 Cheker Square, E Hazel Crest, IL 60429 | 2016-04-22 |
| 1427423367 | Andrea Leigh Warren | Nurse Practitioner | 17800 S. Kedzie Ave, Hazel Crest, IL 60429 | 2015-12-03 |
| 1770969354 | Karriem's Developmental Services | Day Training, Developmentally Disabled Services | 18513 River Road, Hazel Crest, IL 60429 | 2015-08-05 |
| 1073905170 | James Kamper | Physical Therapy Assistant | 1816 W 170th Street, Hazel Crest, IL 60429 | 2015-02-26 |
| 1194066019 | Marilyn C Scott | Psychologist | 18505 Meadow Ln., Hazel Crest, IL 60429 | 2013-03-04 |
| 1649548405 | Supported Independence | Community/Behavioral Health | 17009 Elm Drive, Hazel Crest, IL 60429 | 2011-12-08 |
| Find all providers in zip 60429 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477169522 | Priority Assist Pllc | Physician Assistant | 48 Glenda Ln, Plano, IL 60545-9652 | 2020-09-23 |
| 1154944478 | Diana Goldak | Physician Assistant | 3855 N Parkway Dr Apt 3a, Northbrook, IL 60062-7218 | 2020-05-20 |
| 1033742580 | Colleen Courtney | Physician Assistant | 218 S Driftwood Trl, Mchenry, IL 60050-5454 | 2020-02-12 |
| 1326678962 | Nina Kodros | Physician Assistant | 301 Madison St Ste 280, Joliet, IL 60435-6672 | 2020-01-23 |
| 1689218190 | Jennifer Richman | Physician Assistant | 1890 Silver Cross Blvd Ste 410, New Lenox, IL 60451-9547 | 2019-10-29 |
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1962065516 | Jorge Mantilla | Physician Assistant | 5540 N Kimball Ave Apt 3e, Chicago, IL 60625-4674 | 2019-04-18 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1548739782 | Helen Finke | Physician Assistant | 880 W Central Rd Ste 3300, Arlington Heights, IL 60005-2366 | 2018-11-16 |
| Find all providers with the same taxonomy | ||||
| City | HAZEL CREST |
| Zip Code | 60429 |
Please comment or provide details below to improve the information on JUSTIN LEE SHANK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.