Provider Demographics
NPI:1578735858
Name:ELAINE J. SHAPIRO,D.P.M.,P.C.
Entity Type:Organization
Organization Name:ELAINE J. SHAPIRO,D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:JANET
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:520-297-1366
Mailing Address - Street 1:1625 W INA RD
Mailing Address - Street 2:STE 117
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1975
Mailing Address - Country:US
Mailing Address - Phone:520-297-1366
Mailing Address - Fax:520-297-0129
Practice Address - Street 1:1625 W INA RD
Practice Address - Street 2:STE 117
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1975
Practice Address - Country:US
Practice Address - Phone:520-297-1366
Practice Address - Fax:520-297-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0174213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0766260001Medicare NSC