Individual
DR. RICHARD M. SHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 E CHICAGO AVE # 9, CHICAGO, IL 60611-2991
(312) 227-4500
(312) 227-9785
Mailing address
225 E CHICAGO AVE # 9, CHICAGO, IL 60611-2991
(312) 227-4500
(312) 227-9785
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
036-077175
IL
2085P0229X
Pediatric Radiology Physician
036-077175
IL
2085R0202X
Diagnostic Radiology Physician
Primary
036.077175
IL
2085R0202X
Diagnostic Radiology Physician
036077175
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077175
—
IL
Enumeration date
09/08/2005
Last updated
11/06/2019
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