MEDICARE: SURESH SHAH 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	207Q00000X	Family Medicine Physician	036-064403	IL

General Provider Information

NPI Number	:	1518040617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURESH SHAH MD

Provider Business Mailing Address
First Line	:	88 SILO RIDGE RD W
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-7331
Country	:	US
Telephone Number	:	708-460-8605
Fax Number	:	708-310-4320

Provider Business Practice Location Address
First Line	:	8012 S CRANDON AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60617-1124
Country	:	US
Telephone Number	:	773-356-5415
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	05/15/2026

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