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General NPI Number Information
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NPI Number | 1659995355
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Entity Type | Organization
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Legal Business Name | ELT4 NC, P.C.
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 444 N MICHIGAN AVE STE 3400
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City | CHICAGO
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State | IL
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Zip | 60611-3980
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Country | US
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Telephone | 919-627-5805
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Fax |
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Provider Business Mailing Address
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Address Line | 444 N MICHIGAN AVE STE 3400
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City | CHICAGO
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State | IL
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Zip | 60611-3980
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Country | US
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Telephone | 919-627-5805
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BIMAL SHAH
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Credential | MD
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Telephone | 919-627-5805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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