Individual
RICKY D SHAPIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
2604 DEMPSTER ST STE 204, PARK RIDGE, IL 60068-8426
(847) 635-7300
(847) 635-7556
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.002100
IL
363A00000X
Physician Assistant
085002100
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085002100
—
IL
01
—
IL7072002
MEDICARE PTAN
IL
01
—
IL7073002
MEDICARE PTAN
IL
Enumeration date
01/10/2006
Last updated
07/23/2025
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