Healthcare Provider Details

I. General information

NPI: 1144407594
Provider Name (Legal Business Name): SONIA SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONIA SHAH M.D.

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 N CICERO AVE STE 203
CHICAGO IL
60641-1650
US

IV. Provider business mailing address

1717 S PRAIRIE AVE APT 906
CHICAGO IL
60616-4342
US

V. Phone/Fax

Practice location:
  • Phone: 773-794-8800
  • Fax: 773-794-8830
Mailing address:
  • Phone: 773-936-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number036121040
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125050036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: