Healthcare Provider Details

I. General information

NPI: 1548204035
Provider Name (Legal Business Name): DAVID M. SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1400
CHICAGO IL
60611-2951
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1400
CHICAGO IL
60611-2951
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4065
  • Fax: 312-695-3999
Mailing address:
  • Phone: 312-695-4065
  • Fax: 312-695-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036-115762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: