MEDICARE: CHIRAG M 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	208100000X	Physical Medicine & Rehabilitation Physician	036117834	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036117834	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1861643801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIRAG M SHAH MD

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 118
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3835
Country	:	US
Telephone Number	:	312-942-8905
Fax Number	:	312-942-2384

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 118
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3835
Country	:	US
Telephone Number	:	312-942-8905
Fax Number	:	312-942-2384

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/03/2012

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Directions to “ CHIRAG M SHAH MD” Practice Location

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