Provider Demographics
NPI:1174150403
Name:GEORGE, SHAWN (DO)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E. 22ND STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-932-2055
Mailing Address - Fax:630-932-2059
Practice Address - Street 1:500 E. 22ND STREET
Practice Address - Street 2:SUITE A
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-932-2055
Practice Address - Fax:630-932-2059
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.075568207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine