Provider Demographics
NPI:1063613685
Name:SHAPIRO, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:847-675-9500
Mailing Address - Fax:847-675-9501
Practice Address - Street 1:4318 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60712
Practice Address - Country:US
Practice Address - Phone:847-675-9500
Practice Address - Fax:847-675-9501
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6543208600000X
IL036128040208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL789510OtherGROUP MEDICARE PTAN
IL789511OtherGROUP MEDICARE PTAN
ILDC4196OtherGROUP MEDICARE RAILROAD PTAN
ILP00960003OtherMEDICARE RAILROAD INDIVIDUAL PTAN
ILP00960003OtherMEDICARE RAILROAD INDIVIDUAL PTAN
ILDC4196OtherGROUP MEDICARE RAILROAD PTAN
IL789510005Medicare PIN