Provider Demographics
NPI:1871669325
Name:SHAPIRO, MICHAEL S (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
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 1:75 MARKET ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5093
Mailing Address - Country:US
Mailing Address - Phone:847-697-6290
Mailing Address - Fax:847-697-0252
Practice Address - Street 1:75 MARKET ST
Practice Address - Street 2:SUITE 14
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5093
Practice Address - Country:US
Practice Address - Phone:847-697-6290
Practice Address - Fax:847-697-0252
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD89242Medicare UPIN
IL636740Medicare ID - Type Unspecified