Provider Demographics
NPI:1366707614
Name:SHIMASAKI, TEPPEI (MD)
Entity type:Individual
Prefix:
First Name:TEPPEI
Middle Name:
Last Name:SHIMASAKI
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 1:600 S PAULINA ST
Mailing Address - Street 2:SUITE 143
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-5865
Mailing Address - Fax:312-942-8200
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:SUITE 143
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-5865
Practice Address - Fax:312-942-8200
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI390200000X
IL125066191390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program