Healthcare Provider Details

I. General information

NPI: 1306905880
Provider Name (Legal Business Name): MADELEINE ULLMAN SHALOWITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST SUITE 800
EVANSTON IL
60201-1777
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON HOSPITAL
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2033
  • Fax: 847-364-7468
Mailing address:
  • Phone: 847-570-1206
  • Fax: 847-570-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036059173
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: