Provider Demographics
NPI:1124042338
Name:SHAFFER, LEMUEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:LEMUEL
Middle Name:JOSEPH
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307-09 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2451
Mailing Address - Country:US
Mailing Address - Phone:708-780-9777
Mailing Address - Fax:708-780-9787
Practice Address - Street 1:2307-09 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60804-2451
Practice Address - Country:US
Practice Address - Phone:708-780-9777
Practice Address - Fax:708-780-9787
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072466207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL367830Medicare ID - Type Unspecified
367830Medicare PIN
ILD15589Medicare UPIN