Healthcare Provider Details

I. General information

NPI: 1942578703
Provider Name (Legal Business Name): RACHNA SHAH MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 WEST NORTH AVE #310
MELROSE PARK IL
60160
US

IV. Provider business mailing address

675 WEST NORTH AVE #310
MELROSE PARK IL
60160
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-5054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number36-122188
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36-122188
License Number StateIL

VIII. Authorized Official

Name: DR. RACHNA SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 216-288-1154