Healthcare Provider Details

I. General information

NPI: 1235238973
Provider Name (Legal Business Name): MICHAEL J. SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 E DEMPSTER ST SUITE 400
DES PLAINES IL
60016-5315
US

IV. Provider business mailing address

2454 E DEMPSTER ST STE 400
DES PLAINES IL
60016-5320
US

V. Phone/Fax

Practice location:
  • Phone: 847-299-0700
  • Fax: 847-390-0616
Mailing address:
  • Phone: 847-299-0700
  • Fax: 847-390-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number36070891
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036070891
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: