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General NPI Number Information
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NPI Number | 1316135841
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Entity Type | Organization
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Legal Business Name | UDAY SHAH MD SC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 9133 S STONY ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60617-3936
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Country | US
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Telephone | 773-221-4645
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Fax | 773-221-4849
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Provider Business Mailing Address
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Address Line | 9133 S STONY ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60617-3936
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Country | US
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Telephone | 773-221-4645
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Fax | 773-221-4849
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. UDAY SHAH
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Credential | MD
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Telephone | 773-221-4645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036057749
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License Number State | IL
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