Provider Demographics
NPI:1689011439
Name:SHU, LAURA GUANGYING (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GUANGYING
Last Name:SHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GUANGYING
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:909 DAVIS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3683
Mailing Address - Country:US
Mailing Address - Phone:847-866-3700
Mailing Address - Fax:847-866-3731
Practice Address - Street 1:909 DAVIS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3683
Practice Address - Country:US
Practice Address - Phone:847-866-3700
Practice Address - Fax:847-866-3731
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062602207Q00000X
IL036-139023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine