Provider Demographics
NPI:1356527964
Name:S. SHUBER MD SC
Entity type:Organization
Organization Name:S. SHUBER MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-589-2600
Mailing Address - Street 1:7237 W. IRVING PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-589-2600
Mailing Address - Fax:773-625-4460
Practice Address - Street 1:7237 W. IRVING PARK ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:773-589-2600
Practice Address - Fax:773-625-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045370207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105966-1Medicaid
IL200144Medicare PIN
IL036105966-1Medicaid