MEDICARE: DR. TRUDY M SHADY MD

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	207RP1001X	Pulmonary Disease Physician	R3L47	MO
2	207R00000X	Internal Medicine Physician	036-089376	IL
3	207RP1001X	Pulmonary Disease Physician	036-089376	IL

General Provider Information

NPI Number	:	1417940354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRUDY M SHADY MD

Provider Business Mailing Address
First Line	:	4500 MEMORIAL DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5360
Country	:	US
Telephone Number	:	618-257-4644
Fax Number	:	618-257-6946

Provider Business Practice Location Address
First Line	:	4600 MEMORIAL DR STE 200
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5363
Country	:	US
Telephone Number	:	618-233-2220
Fax Number	:	618-233-2555

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	09/02/2020

Similar Medicare Providers

1871599738 — DOUGLAS DOTHAGER MD
Practice Location Address:

4600 MEMORIAL DR STE 200
BELLEVILLE, IL
62226-5363

Practice Phone: 618-233-2220
Practice Fax: 618-233-2555

1568454775 — WILLIAM A CHADWICK M.D.
Practice Location Address:

4600 MEMORIAL DR STE 240
BELLEVILLE, IL
62226-5363

Practice Phone: 618-234-2390
Practice Fax: 618-234-9936

1891778221 — ABDULSALAM JAMOUS MD
Practice Location Address:

4600 MEMORIAL DR STE 200
BELLEVILLE, IL
62226-5363

Practice Phone: 618-233-2220
Practice Fax:

1851371231 — OMER M BADAHMAN MD
Practice Location Address:

4600 MEMORIAL DR STE 200
BELLEVILLE, IL
62226-5363

Practice Phone: 618-233-2220
Practice Fax:

1851318489 — STACIE LAFF M.D.
Practice Location Address:

4600 MEMORIAL DR STE 280
BELLEVILLE, IL
62226-5363

Practice Phone: 618-257-2800
Practice Fax: 618-257-9802

1972694685 — ANGIE MILLS HARRIS DO
Practice Location Address:

4600 MEMORIAL DR STE 260
BELLEVILLE, IL
62226-5363

Practice Phone: 618-257-4100
Practice Fax:

Directions to “ DR. TRUDY M SHADY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.