MEDICARE: KENNETH L. SHAPIRO 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	207R00000X	Internal Medicine Physician	A31431	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00092287	OTHER	CA	RAILROAD MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A314310	OTHER	CA	BLUE SHIELD PIN
3	A31431	OTHER	CA	CA MEDICAL LICENSE
4	10971743	OTHER	CA	CAQH NUMBER
5	4385363	OTHER	CA	AETNA PIN

General Provider Information

NPI Number	:	1336125178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH L. SHAPIRO M.D.

Provider Business Mailing Address
First Line	:	265 POSADA LN
Second Line	:	SUITE C
City	:	TEMPLETON
State	:	CA
Zip	:	93465-4056
Country	:	US
Telephone Number	:	805-239-1488
Fax Number	:	805-227-0263

Provider Business Practice Location Address
First Line	:	265 POSADA LN
Second Line	:	SUITE C
City	:	TEMPLETON
State	:	CA
Zip	:	93465-4056
Country	:	US
Telephone Number	:	805-239-1488
Fax Number	:	805-227-0263

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	11/14/2014

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Directions to “ KENNETH L. SHAPIRO M.D.” Practice Location

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