Healthcare Provider Details

I. General information

NPI: 1952410136
Provider Name (Legal Business Name): RITA ANNE SHAPIRO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST SUITE 130
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

1572 MAPLE AVE NO. 304
EVANSTON IL
60201-4328
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3333
  • Fax: 312-942-4154
Mailing address:
  • Phone: 847-424-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-053028
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036-053028
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-053028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: