Provider Demographics
NPI:1558392175
Name:SHAPIRO, GARY R (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:SHAPIRO
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 1:2500 PRINCETON CT
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1982
Mailing Address - Country:US
Mailing Address - Phone:612-405-2760
Mailing Address - Fax:
Practice Address - Street 1:2500 PRINCETON CT
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1982
Practice Address - Country:US
Practice Address - Phone:612-405-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34879-20207RX0202X
MN27985207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE48924Medicare UPIN
MD406916100Medicare ID - Type Unspecified
MDKR52K683Medicare ID - Type Unspecified