Provider Demographics
NPI:1851350540
Name:SHAPIRO, OTY (MD)
Entity Type:Individual
Prefix:
First Name:OTY
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-777-3042
Mailing Address - Fax:773-725-8400
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-777-3042
Practice Address - Fax:773-725-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609723OtherBCBS PROVIDER #
IL233690OtherHARMONY PROVIDER #
IL208D00000XOtherTAXONOMY #
IL208D00000XOtherTAXONOMY #
IL21609723OtherBCBS PROVIDER #