1306905880 NPI number — MADELEINE ULLMAN SHALOWITZ MD

Table of content: MADELEINE ULLMAN SHALOWITZ MD (NPI 1306905880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306905880 NPI number — MADELEINE ULLMAN SHALOWITZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHALOWITZ
Provider First Name:
MADELEINE
Provider Middle Name:
ULLMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306905880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2650 RIDGE AVE
Provider Second Line Business Mailing Address:
EVANSTON HOSPITAL
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-570-1206
Provider Business Mailing Address Fax Number:
847-570-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CENTRAL ST
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-1777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-570-2033
Provider Business Practice Location Address Fax Number:
847-364-7468
Provider Enumeration Date:
12/08/2006

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: 208000000X , with the licence number:  036059173 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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