MEDICARE: MS. KATHERINE ANNE SHAH PA-C

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	363AS0400X	Surgical Physician Assistant	085.005477	IL

General Provider Information

NPI Number	:	1245612548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE ANNE SHAH PA-C

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE.
Second Line	:	WALGREEN 2507
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-1271
Fax Number	:	847-570-2930

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	773-702-1000
Fax Number	:

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

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	01/13/2026

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