MEDICARE: ALICE SHAU PING MA MD SC

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	261QM2500X	Medical Specialty Clinic/Center	042.619320 36.061694	IL

General Provider Information

NPI Number	:	1386881845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICE SHAU PING MA MD SC

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1208
City	:	CHICAGO
State	:	IL
Zip	:	60611-8701
Country	:	US
Telephone Number	:	312-787-0000
Fax Number	:	312-335-1681

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1208
City	:	CHICAGO
State	:	IL
Zip	:	60611-8701
Country	:	US
Telephone Number	:	312-787-0000
Fax Number	:	312-335-1681

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. ALICE SHAU PING MA
Credential	:	M.D.
Telephone Number	:	312-787-0000

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	04/22/2009

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