Healthcare Provider Details

I. General information

NPI: 1962798801
Provider Name (Legal Business Name): KARINA SHAH GOBIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 310
MELROSE PARK IL
60160-1606
US

IV. Provider business mailing address

675 W NORTH AVE STE 310
MELROSE PARK IL
60160-1606
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-5054
  • Fax: 708-450-9088
Mailing address:
  • Phone: 708-450-5054
  • Fax: 705-450-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64046
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-060259
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number64046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: