=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205748100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMIKA HALL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2026
-----------------------------------------------------
Last Update Date | 09/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4219 BUTTERFIELD RD
-----------------------------------------------------
City | HILLSIDE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60162-1171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-866-1643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 839 N LARAMIE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60651-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-866-1643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------