MEDICARE: DR. LEMUEL JOSEPH SHAFFER 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	207V00000X	Obstetrics & Gynecology Physician	036072466	IL

General Provider Information

NPI Number	:	1124042338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEMUEL JOSEPH SHAFFER M.D.

Provider Business Mailing Address
First Line	:	2307-09 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60804-2451
Country	:	US
Telephone Number	:	708-780-9777
Fax Number	:	708-780-9787

Provider Business Practice Location Address
First Line	:	2307-09 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60804-2451
Country	:	US
Telephone Number	:	708-780-9777
Fax Number	:	708-780-9787

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/15/2012

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