Healthcare Provider Details

I. General information

NPI: 1487774048
Provider Name (Legal Business Name): ALLAN J SHOELSON, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST SUITE 510
CHICAGO IL
60612
US

IV. Provider business mailing address

1611 W HARRISON ST SUITE 510
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-2800
  • Fax: 312-563-2075
Mailing address:
  • Phone: 312-563-2800
  • Fax: 312-563-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLAN J SHOELSON
Title or Position: PRESIDENT
Credential: DPM
Phone: 312-563-2800