Provider Demographics
NPI:1902814593
Name:SHEA, LAURA MCGARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MCGARRY
Last Name:SHEA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 N AVONDALE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1962
Mailing Address - Country:US
Mailing Address - Phone:847-993-7423
Mailing Address - Fax:847-993-7420
Practice Address - Street 1:6323 N AVONDALE AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1962
Practice Address - Country:US
Practice Address - Phone:847-993-7423
Practice Address - Fax:847-993-7420
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005081213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCE8840OtherMEDICARE RR GROUP #
IL0707390001OtherDMERC
ILP00419869OtherMEDICARE RR PTAN #
IL60001380OtherBCBC OF ILLINOIS
IL016005081Medicaid
IL726711OtherMEDICARE PROVIDER #
IL60001380OtherBCBC OF ILLINOIS
IL0707390001OtherDMERC