Healthcare Provider Details

I. General information

NPI: 1295795953
Provider Name (Legal Business Name): SHAH REHAB SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE
CHICAGO IL
60616-2333
US

IV. Provider business mailing address

11413 BURR OAK LN
BURR RIDGE IL
60527-8008
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-5560
  • Fax: 312-328-7732
Mailing address:
  • Phone: 312-567-5560
  • Fax: 312-328-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name: SUBHASH K SHAH
Title or Position: OWNER
Credential: MD
Phone: 773-767-3822