1417136763 NPI number — MRS. AMY JUDITH SHIMONI MED DT

Table of content: MRS. AMY JUDITH SHIMONI MED DT (NPI 1417136763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417136763 NPI number — MRS. AMY JUDITH SHIMONI MED DT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIMONI
Provider First Name:
AMY
Provider Middle Name:
JUDITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED DT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417136763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
551 BROADVIEW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-432-6163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 WASHINGTON STE
Provider Second Line Business Practice Location Address:
SUITE 210 CHILD & FAMILY CONNECTIONS LAKE COUNTY HEALT
Provider Business Practice Location Address City Name:
WAUKEGAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-360-7353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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