Healthcare Provider Details

I. General information

NPI: 1669455044
Provider Name (Legal Business Name): MICHAEL B. SHAPIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 JOHN Q HAMMONS DR
MADISON WI
53717-1959
US

IV. Provider business mailing address

1200 JOHN Q HAMMONS DR STE 100
MADISON WI
53717-1967
US

V. Phone/Fax

Practice location:
  • Phone: 608-827-7705
  • Fax:
Mailing address:
  • Phone: 608-827-7705
  • Fax: 608-827-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number24259
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: