Healthcare Provider Details

I. General information

NPI: 1376552521
Provider Name (Legal Business Name): GAIL JOYCE SHORR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SUITE H
WILMETTE IL
60091-2666
US

IV. Provider business mailing address

470 HIGHCREST DR
WILMETTE IL
60091-2358
US

V. Phone/Fax

Practice location:
  • Phone: 847-256-6480
  • Fax: 847-256-6482
Mailing address:
  • Phone: 847-251-6096
  • Fax: 847-251-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: