Basic Information
| Provider Information | |||||||||
| NPI: | 1184857500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHONIBARE | ||||||||
| FirstName: | SEGUN | ||||||||
| MiddleName: | SADIQUE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E 33RD ST | ||||||||
| Address2: | APT# 2005 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606164055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732634812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1325 N HIGHLAND AVE | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605061449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308592222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2009 | ||||||||
| LastUpdateDate: | 09/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 209007761 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.