Individual
RONALD DEAN SHORE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
Mailing address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-6228
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085004625
IL
363A00000X
Physician Assistant
Primary
56824
CA
Other
Enumeration date
04/01/2013
Last updated
12/27/2024
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