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General NPI Number Information
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NPI Number | 1457330425
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Entity Type | Individual
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Provider Name | RICKY D SHAPIRO PA C
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 2604 DEMPSTER ST STE 204
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City | PARK RIDGE
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State | IL
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Zip | 60068-8426
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Country | US
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Telephone | 847-635-7300
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Fax | 847-635-7556
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Provider Business Mailing Address
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Address Line | PO BOX 603725
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City | CHARLOTTE
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State | NC
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Zip | 28260-3725
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Country | US
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Telephone | 828-575-2625
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Fax | 828-350-2174
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085002100
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.002100
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License Number State | IL
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