Provider Demographics
NPI:1518932227
Name:SHAPIRO, MISHAIL A (DO)
Entity Type:Individual
Prefix:DR
First Name:MISHAIL
Middle Name:A
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1730 PARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2688
Mailing Address - Country:US
Mailing Address - Phone:630-718-0200
Mailing Address - Fax:630-718-0900
Practice Address - Street 1:114 W ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2774
Practice Address - Country:US
Practice Address - Phone:847-353-8802
Practice Address - Fax:847-353-8812
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036100018207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100018Medicaid
ILF53271Medicare UPIN