Healthcare Provider Details

I. General information

NPI: 1346747185
Provider Name (Legal Business Name): UJASH SHETH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date: 11/16/2018
Reactivation Date: 11/28/2018

III. Provider practice location address

251 EAST HURON STREET NORTHWESTERN MEMORIAL HOSPITAL
CHICAGO IL
60611
US

IV. Provider business mailing address

259 E ERIE STREET, 13TH FLOOR
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 312-472-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: