Provider Demographics
NPI:1750340642
Name:SHULMAN, STANFORD TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:TAYLOR
Last Name:SHULMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:BOX 20
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-4187
Mailing Address - Fax:773-880-8226
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:BOX 20
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4187
Practice Address - Fax:773-880-8226
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360426102080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042610Medicaid
ILP08830Medicare ID - Type Unspecified
IL036042610Medicaid