Provider Demographics
NPI:1346700903
Name:DORSEY, SHANE PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:PATRICK
Last Name:DORSEY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE G155
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2570
Mailing Address - Fax:847-733-5224
Practice Address - Street 1:2650 RIDGE AVE STE G155
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1700
Practice Address - Country:US
Practice Address - Phone:847-570-2570
Practice Address - Fax:847-733-5224
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361694442084N0400X
LA3301222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology