| Shirley A Roy, Mdsc | |
|
5419 N Sheridan Rd 106 Chicago IL 60640-1964 | |
| (773) 878-5151 | |
| (773) 878-1134 |
| Full Name | Shirley A Roy, Mdsc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5419 N Sheridan Rd, Chicago, Illinois |
| Authorized Official Name and Position | Shirley A Roy (PRESIDENT) |
| Authorized Official Contact | 7738785151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shirley A Roy, Mdsc 5419 N Sheridan Rd 106 Chicago IL 60640-1964 Ph: (773) 878-5151 | Shirley A Roy, Mdsc 5419 N Sheridan Rd 106 Chicago IL 60640-1964 Ph: (773) 878-5151 |
| NPI Number | 1083710263 |
|---|---|
| Provider Enumeration Date | 09/15/2006 |
| Last Update Date | 10/03/2007 |
| Medicare PECOS PAC ID | 0547277634 |
|---|---|
| Medicare Enrollment ID | O20060315000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083710263 | NPI | - | NPPES |
| 36045111 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 3645111 (Illinois) | Primary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | 3645111 (Illinois) | Secondary |
| Provider Name | Shirley A Roy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588683460 PECOS PAC ID: 4688681778 Enrollment ID: I20060321000126 |
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