MEDICARE: SHIRLEY A ROY, MDSC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	3645111	IL
2	207R00000X	Internal Medicine Physician	3645111	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083710263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRLEY A ROY, MDSC

Provider Business Mailing Address
First Line	:	5419 N SHERIDAN RD
Second Line	:	106
City	:	CHICAGO
State	:	IL
Zip	:	60640-1964
Country	:	US
Telephone Number	:	773-878-5151
Fax Number	:	773-878-1134

Provider Business Practice Location Address
First Line	:	5419 N SHERIDAN RD
Second Line	:	106
City	:	CHICAGO
State	:	IL
Zip	:	60640-1964
Country	:	US
Telephone Number	:	773-878-5151
Fax Number	:	773-878-1134

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHIRLEY A ROY
Credential	:	MD
Telephone Number	:	773-878-5151

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	10/03/2007

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Directions to “SHIRLEY A ROY, MDSC ” Practice Location

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