MEDICARE: DR. ANITA A SHAH D.O.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036135684	IL
2	207RP1001X	Pulmonary Disease Physician	036135684	IL

General Provider Information

NPI Number	:	1760534192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA A SHAH D.O.

Provider Business Mailing Address
First Line	:	7447 W TALCOTT AVE STE 542
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3716
Country	:	US
Telephone Number	:	773-631-2180
Fax Number	:	773-631-5947

Provider Business Practice Location Address
First Line	:	7447 W TALCOTT AVE STE 542
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3716
Country	:	US
Telephone Number	:	773-631-2180
Fax Number	:	773-631-5947

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	12/30/2021

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