Healthcare Provider Details

I. General information

NPI: 1790805323
Provider Name (Legal Business Name): ALLAN J SHOELSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

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 STREET SUITE 510
CHICAGO IL
60612
US

IV. Provider business mailing address

1611 W HARRISON STREET 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 Number016003603
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: