Healthcare Provider Details

I. General information

NPI: 1972598233
Provider Name (Legal Business Name): SHANTA NAIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10537 S ROBERTS RD
PALOS HILLS IL
60465-1933
US

IV. Provider business mailing address

METROPOLITAN FAMILY SERVICES 1 NORTH DEARBORN STREET
CHICAGO IL
60602-4322
US

V. Phone/Fax

Practice location:
  • Phone: 708-974-2300
  • Fax: 708-974-2498
Mailing address:
  • Phone: 312-986-4454
  • Fax: 312-986-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036069956
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: