Provider Demographics
NPI:1962411793
Name:YAMADA, SHISHIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHISHIN
Middle Name:
Last Name:YAMADA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:STE 550
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9579
Mailing Address - Country:US
Mailing Address - Phone:815-714-9362
Mailing Address - Fax:815-846-1777
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:PAVILION A, SUITE 560
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9583
Practice Address - Country:US
Practice Address - Phone:815-714-9362
Practice Address - Fax:815-846-1777
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-05-13
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Provider Licenses
StateLicense IDTaxonomies
IL036112458208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112458Medicaid
IL036112458Medicaid