Provider Demographics
NPI:1326026139
Name:SHAPIRO, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WAUKEGAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2724
Mailing Address - Country:US
Mailing Address - Phone:847-242-6600
Mailing Address - Fax:847-242-6605
Practice Address - Street 1:211 WAUKEGAN RD STE 200
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2724
Practice Address - Country:US
Practice Address - Phone:847-242-6600
Practice Address - Fax:847-242-6605
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1326026139OtherNPI
L71412Medicare PIN
ILC50418Medicare UPIN