MEDICARE: SHAWNI S MOSHIRI DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016-004154	IL

General Provider Information

NPI Number	:	1255463576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNI S MOSHIRI DPM

Provider Business Mailing Address
First Line	:	PO BOX 11232
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-0232
Country	:	US
Telephone Number	:	312-550-0224
Fax Number	:	773-376-9211

Provider Business Practice Location Address
First Line	:	2801 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3513
Country	:	US
Telephone Number	:	312-550-0224
Fax Number	:	773-376-9211

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	05/24/2013

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