Provider Demographics
NPI:1528063559
Name:SHOENER, DEAN P (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:P
Last Name:SHOENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2542
Mailing Address - Country:US
Mailing Address - Phone:630-208-7874
Mailing Address - Fax:630-208-7880
Practice Address - Street 1:1665 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2542
Practice Address - Country:US
Practice Address - Phone:630-208-7874
Practice Address - Fax:630-208-7880
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099967208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN GROUP
IL036099967Medicaid
ILF400118964OtherMEDICARE INDIVIDUAL PTAN
IL206147OtherMEDICARE PTAN GROUP
ILG93677Medicare UPIN