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NPI Code Detail

MEDICARE: MERRICK SHOR

MEDICARE: MERRICK SHOR
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
12085R0202XDiagnostic Radiology PhysicianIL

General Provider Information

NPI Number : 1336171420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MERRICK SHOR
Provider Business Mailing Address
First Line : 1901 W HARRISON ST
Second Line : RM 2533
City : CHICAGO
State : IL
Zip : 60612-3714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1901 W HARRISON ST
Second Line : RM 2533
City : CHICAGO
State : IL
Zip : 60612-3714
Country : US
Telephone Number : 312-864-3825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/08/2007

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Directions to “ MERRICK SHOR ” Practice Location

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