MEDICARE: JERROLD E SHAPIRO 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	207RC0000X	Cardiovascular Disease Physician	036042757	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	:	1538388806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERROLD E SHAPIRO MD

Provider Business Mailing Address
First Line	:	6374 N LINCOLN AVE
Second Line	:	SUITE 303
City	:	CHICAGO
State	:	IL
Zip	:	60659-1283
Country	:	US
Telephone Number	:	773-588-5900
Fax Number	:	773-588-5775

Provider Business Practice Location Address
First Line	:	6374 N LINCOLN AVE
Second Line	:	SUITE 303
City	:	CHICAGO
State	:	IL
Zip	:	60659-1283
Country	:	US
Telephone Number	:	773-588-5900
Fax Number	:	773-588-5775

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	09/23/2016

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Directions to “ JERROLD E SHAPIRO MD” Practice Location

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