MEDICARE: DR. ROBERT DENNIS SHELBY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		IL
2	1041C0700X	Clinical Social Worker		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001671068	OTHER	IL	BLUE CROSS ILLINOIS

General Provider Information

NPI Number	:	1154333862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DENNIS SHELBY LCSW

Provider Business Mailing Address
First Line	:	180 N MICHIGAN AVE STE 2413
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7474
Country	:	US
Telephone Number	:	219-406-0571
Fax Number	:	312-726-5716

Provider Business Practice Location Address
First Line	:	180 N MICHIGAN AVE STE 2413
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7474
Country	:	US
Telephone Number	:	219-406-0571
Fax Number	:	312-726-5716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/11/2025

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