Provider Demographics
NPI:1497775951
Name:SHAPIRO SURGICAL ASSOCIATES SC
Entity Type:Organization
Organization Name:SHAPIRO SURGICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-641-1150
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:SUITE 1709
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1903
Mailing Address - Country:US
Mailing Address - Phone:312-641-1150
Mailing Address - Fax:312-332-0299
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:SUITE 1709
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:312-641-1150
Practice Address - Fax:312-332-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601666OtherBCBS OF IL
ILD13404Medicare UPIN
IL746900Medicare ID - Type Unspecified