MEDICARE: DR. SHASHI KIRAN BELLAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036102726	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036102726	IL
3	207RP1001X	Pulmonary Disease Physician	036102726	IL

General Provider Information

NPI Number	:	1053338871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHASHI KIRAN BELLAM MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-3175
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	1000 CENTRAL ST STE 615
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1779
Country	:	US
Telephone Number	:	847-570-2714
Fax Number	:	847-733-5109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	12/29/2025

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