Healthcare Provider Details

I. General information

NPI: 1124042338
Provider Name (Legal Business Name): LEMUEL JOSEPH SHAFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307-09 S CICERO AVE
CHICAGO IL
60804-2451
US

IV. Provider business mailing address

2307-09 S CICERO AVE
CHICAGO IL
60804-2451
US

V. Phone/Fax

Practice location:
  • Phone: 708-780-9777
  • Fax: 708-780-9787
Mailing address:
  • Phone: 708-780-9777
  • Fax: 708-780-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036072466
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: