Provider Demographics
NPI:1588683460
Name:ROY, SHIRLEY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:ROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5419 N SHERIDAN RD
Mailing Address - Street 2:#106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-878-5151
Mailing Address - Fax:773-878-1134
Practice Address - Street 1:5419 N SHERIDAN RD
Practice Address - Street 2:#106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1964
Practice Address - Country:US
Practice Address - Phone:773-878-5151
Practice Address - Fax:773-878-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1588683460207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36045111Medicaid
213235Medicare ID - Type Unspecified
IL36045111Medicaid