MEDICARE: THOMAS J SHULA 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	174400000X	Specialist	036074760	IL
2	2080P0202X	Pediatric Cardiology Physician	036-074760	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	:	1760486245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J SHULA MD

Provider Business Mailing Address
First Line	:	444 ROXBURY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5059
Country	:	US
Telephone Number	:	815-227-5600
Fax Number	:	815-227-9242

Provider Business Practice Location Address
First Line	:	444 ROXBURY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5059
Country	:	US
Telephone Number	:	815-227-5600
Fax Number	:	815-227-9242

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	02/23/2016

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Directions to “ THOMAS J SHULA MD” Practice Location

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