MEDICARE: NASREEN SHAH M.D.

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	036-090392	IL

General Provider Information

NPI Number	:	1225119035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASREEN SHAH M.D.

Provider Business Mailing Address
First Line	:	2720 W 15TH ST
Second Line	:	4TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60608-1610
Country	:	US
Telephone Number	:	773-257-6730
Fax Number	:	773-257-4775

Provider Business Practice Location Address
First Line	:	2720 W 15TH ST
Second Line	:	4TH FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60608-1610
Country	:	US
Telephone Number	:	773-257-6730
Fax Number	:	773-257-4775

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	05/14/2012

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