Provider Demographics
NPI:1972742872
Name:MAUREEN MCSHANE DPM LLC
Entity Type:Organization
Organization Name:MAUREEN MCSHANE DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-233-0990
Mailing Address - Street 1:11238 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4116
Mailing Address - Country:US
Mailing Address - Phone:773-233-0990
Mailing Address - Fax:773-233-0992
Practice Address - Street 1:11238 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4116
Practice Address - Country:US
Practice Address - Phone:773-233-0990
Practice Address - Fax:773-233-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004635213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001605234OtherBC/BS OF ILLINOIS
IL6328540001Medicare NSC
IL339600Medicare PIN
IL001605234OtherBC/BS OF ILLINOIS