Individual
OTY SHAPIRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5600 W ADDISON ST, SUITE 302, CHICAGO, IL 60634-4401
(773) 777-3042
(773) 725-8400
Mailing address
5600 W ADDISON ST, SUITE 302, CHICAGO, IL 60634-4401
(773) 777-3042
(773) 725-8400
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208D00000X
TAXONOMY #
IL
01
—
21609723
BCBS PROVIDER #
IL
01
—
233690
HARMONY PROVIDER #
IL
Enumeration date
03/21/2006
Last updated
07/09/2007
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