Organization
JERROLD SHAPIRO MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERROLD EDWIN SHAPIRO MD (PRESIDENT)
(773) 588-5900
Entity
Organization
Contact information
Practice address
6374 N LINCOLN AVE, SUITE 303, CHICAGO, IL 60659-1283
(773) 588-5900
(773) 588-5775
Mailing address
6374 N LINCOLN AVE, SUITE 303, CHICAGO, IL 60659-1283
(773) 588-5900
(773) 588-5775
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036042757
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036042757
—
IL
01
—
207RC0000X
TAXONOMY
IL
Enumeration date
12/15/2010
Last updated
09/17/2016
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