MEDICARE: DR. DAVID MICHAEL SHORE 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	208800000X	Urology Physician	036-129535	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	:	1184823163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL SHORE M.D.

Provider Business Mailing Address
First Line	:	1011 W WELLINGTON AVE
Second Line	:	STE. 200
City	:	CHICAGO
State	:	IL
Zip	:	60657-4325
Country	:	US
Telephone Number	:	773-280-1011
Fax Number	:	773-281-1029

Provider Business Practice Location Address
First Line	:	1011 W WELLINGTON AVE
Second Line	:	STE. 200
City	:	CHICAGO
State	:	IL
Zip	:	60657-4325
Country	:	US
Telephone Number	:	773-280-1011
Fax Number	:	773-281-1029

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/12/2019

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