Provider Demographics
NPI:1215478946
Name:SHABAD, PETER I (PHD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:SHABAD
Suffix:I
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:SHABAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7401
Mailing Address - Country:US
Mailing Address - Phone:312-739-0092
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE540
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:312-739-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003353102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst