Healthcare Provider Details

I. General information

NPI: 1154777159
Provider Name (Legal Business Name): STELLAR PAIN AND SPINE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 N ASHLAND AVE 1N
CHICAGO IL
60622-5684
US

IV. Provider business mailing address

921 SHERWOOD DR
LAKE BLUFF IL
60044-2203
US

V. Phone/Fax

Practice location:
  • Phone: 773-280-7001
  • Fax: 773-280-7597
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036129958
License Number StateIL

VIII. Authorized Official

Name: DR. SAMEER SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 224-880-6563