MEDICARE: SHMUEL PRICE DO

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	207R00000X	Internal Medicine Physician	036167073	IL
2	208M00000X	Hospitalist Physician	036167073	IL

General Provider Information

NPI Number	:	1356922272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHMUEL PRICE DO

Provider Business Mailing Address
First Line	:	150 HARVESTER DR STE 300
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-5965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6212 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2208
Country	:	US
Telephone Number	:	443-602-6260
Fax Number	:

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	03/11/2025

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Directions to “ SHMUEL PRICE DO” Practice Location

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