1700047222 NPI number — DR. KABITA SHEILA SHIFRIN D.O.

Table of content: DR. KABITA SHEILA SHIFRIN D.O. (NPI 1700047222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700047222 NPI number — DR. KABITA SHEILA SHIFRIN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIFRIN
Provider First Name:
KABITA
Provider Middle Name:
SHEILA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAS
Provider Other First Name:
KABITA
Provider Other Middle Name:
SHEILA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAIDEN NAME
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700047222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2335 S MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60616-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-590-3572
Provider Business Mailing Address Fax Number:
888-716-0671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 S MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-590-3572
Provider Business Practice Location Address Fax Number:
888-716-0671
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  036126041 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0200X , with the licence number: 036.126041 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083684922 . This is a "ESC THE EYE SPECIALISTS CENTER, LLC GROUP NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1699802421 . This is a "ESC OPTICAL NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036126041 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK7818 . This is a "ESC MEDICARE RAILROAD GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IL6821 . This is a "SHIFRIN GRP MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 205785 . This is a "ESC GRP ILL MEDICARE PTAN COOK COUNTY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00928033 . This is a "ESC MEDICARE RAILROAD INDIVIDUAL PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 205785004 . This is a "ESC MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01620861 . This is a "ESC BLUE CROSS BLUE SHEILD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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