Provider Demographics
NPI:1679637144
Name:MA, ALICE SHAU PING (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:SHAU PING
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAU PING
Other - Middle Name:ALICE
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-787-0000
Mailing Address - Fax:312-335-1681
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 1208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-787-0000
Practice Address - Fax:312-335-1681
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061694207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01623112OtherBLUE CROSS BLUE SHIELDS
E31022Medicare UPIN
01623112OtherBLUE CROSS BLUE SHIELDS