Provider Demographics
NPI:1952410136
Name:SHAPIRO, RITA ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:ANNE
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 MAPLE AVE
Mailing Address - Street 2:NO. 304
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4328
Mailing Address - Country:US
Mailing Address - Phone:847-424-0447
Mailing Address - Fax:
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:SUITE 130
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-3333
Practice Address - Fax:312-942-4154
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053028207R00000X, 207RG0300X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDVA00Medicare UPIN
ILVAD000Medicare UPIN