MEDICARE: JULIA EVE SHAUGER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	016-004714	IL
2	213ES0131X	Foot Surgery Podiatrist	070009324A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4618176	OTHER	IL	DEPT OF LABOR
2	1632534	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1083628101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA EVE SHAUGER DPM

Provider Business Mailing Address
First Line	:	1757 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1812
Country	:	US
Telephone Number	:	708-799-7500
Fax Number	:	708-798-4563

Provider Business Practice Location Address
First Line	:	1757 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1812
Country	:	US
Telephone Number	:	708-799-7500
Fax Number	:	708-798-4563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/05/2007

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Directions to “ JULIA EVE SHAUGER DPM” Practice Location

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