Healthcare Provider Details

I. General information

NPI: 1518932227
Provider Name (Legal Business Name): MISHAIL A SHAPIRO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W ROCKLAND RD
LIBERTYVILLE IL
60048-2774
US

IV. Provider business mailing address

114 W ROCKLAND RD STE 101
LIBERTYVILLE IL
60048-2797
US

V. Phone/Fax

Practice location:
  • Phone: 847-353-8802
  • Fax: 847-353-8812
Mailing address:
  • Phone: 847-353-8802
  • Fax: 866-700-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036100018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: