Basic Information
| Provider Information | |||||||||
| NPI: | 1184740524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAW | ||||||||
| FirstName: | ELEANOR | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4969 BENCHMARK CENTRE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622268928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182352311 | ||||||||
| FaxNumber: | 6185893335 | ||||||||
| Practice Location | |||||||||
| Address1: | 4969 BENCHMARK CENTRE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622268928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182352311 | ||||||||
| FaxNumber: | 6185893335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036081980 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.