MEDICARE: MR. KALPESH M SHAH

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	183500000X	Pharmacist	051031784	IL
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1255586665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KALPESH M SHAH

Provider Business Mailing Address
First Line	:	401 E 61ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2324
Country	:	US
Telephone Number	:	773-667-4400
Fax Number	:	773-667-5040

Provider Business Practice Location Address
First Line	:	401 E 61ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2324
Country	:	US
Telephone Number	:	773-667-4400
Fax Number	:	773-667-5040

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

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	03/16/2009

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