Healthcare Provider Details

I. General information

NPI: 1083681431
Provider Name (Legal Business Name): NORTH SUBURBAN PULMONARY & CRITICAL CARE CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 WAUKEGAN RD
MORTON GROVE IL
60053-2102
US

IV. Provider business mailing address

9201 WAUKEGAN RD
MORTON GROVE IL
60053
US

V. Phone/Fax

Practice location:
  • Phone: 847-759-4770
  • Fax: 847-759-8824
Mailing address:
  • Phone: 847-759-4770
  • Fax: 847-759-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number042617267
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042617267
License Number StateIL

VIII. Authorized Official

Name: BHAVEN SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-759-4770