Active NPI
Mitchell Brian McShane, DMD
- Dentist
- Elk Grove VLG, IL
National Provider Identifier
1891469664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.033327
- Practice address
- 901 Biesterfield Rd
Elk Grove VLG, IL 60007-3392 - Phone
- (847) 437-8366
- NPI assigned
- Aug 5, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.033327 | IL | Primary |
Addresses
Primary practice location
901 Biesterfield Rd
Elk Grove VLG, IL 60007-3392
Mailing address
901 Biesterfield Rd
Elk Grove VLG, IL 60007-3392
Phone (847) 437-8366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033327 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1891469664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 BIESTERFIELD RD",
"city": "ELK GROVE VLG",
"state": "IL",
"postal_code": "600073392",
"telephone_number": "847-437-8366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 BIESTERFIELD RD",
"city": "ELK GROVE VLG",
"state": "IL",
"postal_code": "600073392",
"telephone_number": "847-437-8366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCSHANE",
"first_name": "MITCHELL",
"middle_name": "BRIAN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-05",
"last_updated": "2021-09-09",
"certification_date": "2021-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.033327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove VLG, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.