Provider Demographics
NPI:1861599342
Name:SHAN, TANVEER (MD,)
Entity type:Individual
Prefix:DR
First Name:TANVEER
Middle Name:
Last Name:SHAN
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 1:901 E SOUTHWIND RD
Mailing Address - Street 2:MCFARLAND MHC
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5125
Mailing Address - Country:US
Mailing Address - Phone:217-786-6994
Mailing Address - Fax:
Practice Address - Street 1:901 E SOUTHWIND RD
Practice Address - Street 2:MCFARLAND MHC
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5125
Practice Address - Country:US
Practice Address - Phone:217-786-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-016002084P0800X
IL0360932872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG35830Medicare UPIN
IL564630Medicare ID - Type Unspecified