Healthcare Provider Details

I. General information

NPI: 1750515300
Provider Name (Legal Business Name): NORTHWEST SUBURBAN PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 NEW WILKE RD BLDG 2 SUITE 200
ROLLING MEADOWS IL
60008-4506
US

IV. Provider business mailing address

5999 NEW WILKE RD BLDG 2
ROLLING MEADOWS IL
60008-4506
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-7107
  • Fax: 847-255-7031
Mailing address:
  • Phone: 847-255-7107
  • Fax: 847-255-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GHANSHYAM S SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-255-7107