Shane Wa Irgens, PT | |
1300 N Ashland Ave, Suite G, Chicago, IL 60622-2268 | |
(773) 252-6227 | |
Not Available |
Full Name | Shane Wa Irgens |
---|---|
Gender | Male |
Speciality | Physical Therapy |
Experience | 14 Years |
Location | 1300 N Ashland Ave, Chicago, Illinois |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679876015 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 070-018218 (Illinois) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Bohannan Irgens Group Llc | 2365732757 | 4 |
Provider Name | Bohannan Irgens Group Llc |
---|---|
Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1417313925 PECOS PAC ID: 2365732757 Enrollment ID: O20160525002947 |
Mailing Address | Practice Location Address |
---|---|
Shane Wa Irgens, PT 790 Remington Blvd, Bolingbrook, IL 60440-4909 Ph: (630) 296-2223 | Shane Wa Irgens, PT 1300 N Ashland Ave, Suite G, Chicago, IL 60622-2268 Ph: (773) 252-6227 |
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