Provider Demographics
NPI:1487774048
Name:ALLAN J SHOELSON, DPM, PC
Entity type:Organization
Organization Name:ALLAN J SHOELSON, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHOELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-563-2800
Mailing Address - Street 1:1611 W HARRISON ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-563-2800
Mailing Address - Fax:312-563-2075
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:SUITE 510
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-563-2800
Practice Address - Fax:312-563-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632253OtherBCBS
ILT38806Medicare UPIN
IL1632253OtherBCBS