Healthcare Provider Details

I. General information

NPI: 1891749677
Provider Name (Legal Business Name): MICHAEL SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

259 E ERIE ST
CHICAGO IL
60611-2987
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8918
  • Fax: 312-695-3644
Mailing address:
  • Phone: 312-695-8918
  • Fax: 312-695-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036106367
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036106367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: