MEDICARE: DR. SHIBANI MUNSHI M.D.

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	207Q00000X	Family Medicine Physician	248893	NY
2	207Q00000X	Family Medicine Physician	036-129908	IL
3	207Q00000X	Family Medicine Physician	56542-20	WI

General Provider Information

NPI Number	:	1083813596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIBANI MUNSHI M.D.

Provider Business Mailing Address
First Line	:	150 E HURON ST STE 1110
Second Line	:	NORTHWESTERN INTEGRATIVE MEDICINE
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:	312-926-6285

Provider Business Practice Location Address
First Line	:	150 E HURON ST STE 1110
Second Line	:	NORTHWESTERN INTEGRATIVE MEDICINE
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:	312-926-6285

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	01/28/2013

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