Basic Information
| Provider Information | |||||||||
| NPI: | 1558750026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHANNAHAN | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | BALABANOVA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1475 E BELVIDERE RD | ||||||||
| Address2: | SUITE 385 | ||||||||
| City: | GRAYSLAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600302012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475357157 | ||||||||
| FaxNumber: | 3126940655 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 E HURON ST STE 1100 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129260896 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2015 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.114607 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.