Healthcare Provider Details

I. General information

NPI: 1003897786
Provider Name (Legal Business Name): BRADLEY D SHAPIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 HASSELL RD
HOFFMAN ESTATES IL
60169-2102
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-7030
  • Fax: 847-843-0795
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036086619
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: