Provider Demographics
NPI:1083628101
Name:SHAUGER, JULIA EVE (DPM)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:EVE
Last Name:SHAUGER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1812
Mailing Address - Country:US
Mailing Address - Phone:708-799-7500
Mailing Address - Fax:708-798-4563
Practice Address - Street 1:1757 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1812
Practice Address - Country:US
Practice Address - Phone:708-799-7500
Practice Address - Fax:708-798-4563
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004714213ES0103X
IN070009324A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4618176OtherDEPT OF LABOR
IL1632534OtherBCBS
ILL93048Medicare PIN
IL4618176OtherDEPT OF LABOR
IL1632534OtherBCBS
ILU48192Medicare UPIN