MEDICARE: DR. ALICE SHAU PING MA M.D.

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	207N00000X	Dermatology Physician	036061694	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01623112	OTHER		BLUE CROSS BLUE SHIELDS

General Provider Information

NPI Number	:	1679637144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE SHAU PING MA M.D.

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1208
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
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	:	60611-4546
Country	:	US
Telephone Number	:	312-787-0000
Fax Number	:	312-335-1681

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/09/2009

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Directions to “ DR. ALICE SHAU PING MA M.D.” Practice Location

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