Basic Information
| Provider Information | |||||||||
| NPI: | 1205916764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAHABI | ||||||||
| FirstName: | SHOHREH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 E SUPERIOR ST STE 5-2168 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3124720120 | ||||||||
| FaxNumber: | 3124724688 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 E SUPERIOR ST STE 4-420 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950990 | ||||||||
| FaxNumber: | 3124724706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 10/16/2017 | ||||||||
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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 | 207V00000X | 48222 | CT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 227982 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | 48222 | CT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207VX0201X | 036137207 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.