Michael Aubrey Shanholtzer, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016003108 Issued in IL

Practice address

500 W Maple St
Suite 206
New Lenox, IL 60451-2908

Phone

(815) 485-3369

Fax

(815) 485-4925

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371513600000",
    "number": "1720180656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 EAGLE VISTA DR",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512313",
            "telephone_number": "815-485-5862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W MAPLE ST",
            "address_2": "SUITE 206",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512908",
            "telephone_number": "815-485-3369",
            "fax_number": "815-485-4925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANHOLTZER",
        "first_name": "MICHAEL",
        "middle_name": "AUBREY",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2013-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016003108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/PRIMARY OFFICE",
            "identifier": "60201194",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/SECOND OFFICE",
            "identifier": "60010777",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Scott, FNP
• Kim Lynn Segvich
• Vanessa L Seisser, PHARMD
• Sarah Shaban
• Elizabeth Shanahan
• Traci Shanklin, N.P.
• Shaping the Path
• Corinne Ladan Shaw, APRN
• Jamie Shefcik
• Michele Shelly, LCSW, CCTP, CSTS

• Podiatrist in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.