Provider Demographics
NPI:1063733038
Name:SANTEK, SHANE ALLEN (DO)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:ALLEN
Last Name:SANTEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 BEAUMONT DRIVE
Mailing Address - Street 2:APT 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:269-547-0661
Mailing Address - Fax:
Practice Address - Street 1:5454 HOHMAN AVENUE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320
Practice Address - Country:US
Practice Address - Phone:219-932-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
IN02004581A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02004581AOtherIN STATE LICENSE
IN02004581BOtherIN CSR
IN02004581BOtherIN CSR