MEDICARE: JERROLD SHAPIRO MD LTD

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	174400000X	Specialist	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
2	207RC0000X	OTHER	IL	TAXONOMY

General Provider Information

NPI Number	:	1609179597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERROLD SHAPIRO MD LTD

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	:	PRESIDENT
Name	:	DR. JERROLD EDWIN SHAPIRO
Credential	:	MD
Telephone Number	:	773-588-5900

Provider Enumeration Date	:	12/15/2010
Last Update Date	:	09/17/2016

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