MEDICARE: OTY 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	208D00000X	General Practice Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21609723	OTHER	IL	BCBS PROVIDER #
2	233690	OTHER	IL	HARMONY PROVIDER #
3	208D00000X	OTHER	IL	TAXONOMY #

General Provider Information

NPI Number	:	1851350540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTY SHAPIRO MD

Provider Business Mailing Address
First Line	:	5600 W ADDISON ST
Second Line	:	SUITE 302
City	:	CHICAGO
State	:	IL
Zip	:	60634-4401
Country	:	US
Telephone Number	:	773-777-3042
Fax Number	:	773-725-8400

Provider Business Practice Location Address
First Line	:	5600 W ADDISON ST
Second Line	:	SUITE 302
City	:	CHICAGO
State	:	IL
Zip	:	60634-4401
Country	:	US
Telephone Number	:	773-777-3042
Fax Number	:	773-725-8400

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/09/2007

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Directions to “ OTY SHAPIRO MD” Practice Location

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