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General NPI Number Information
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NPI Number | 1215906813
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Entity Type | Individual
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Provider Name | JOHN MICHAEL SHORO ATC LAT
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 700 E COUGAR TRL
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60194-3659
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Country | US
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Telephone | 847-755-3790
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 WORDEN WAY
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3153
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Country | US
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Telephone | 847-891-2735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | IL
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