Healthcare Provider Details

I. General information

NPI: 1992628275
Provider Name (Legal Business Name): INDIAN AMERICAN MEDICAL ASSOCIATION CHARITABLE FOUNDATION(IAMACF)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 W. PETERSON AVENUE
CHICAGO IL
60659
US

IV. Provider business mailing address

2645 W. PETERSON AVENUE
CHICAGO IL
60659
US

V. Phone/Fax

Practice location:
  • Phone: 773-275-8630
  • Fax: 773-275-8635
Mailing address:
  • Phone: 773-275-8630
  • Fax: 773-275-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMIR SHAH
Title or Position: CHAIR PERSON
Credential: MD
Phone: 708-638-1546