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General NPI Number Information
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NPI Number | 1780773051
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Entity Type | Organization
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Legal Business Name | SHETH SUSHIL A MD SC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 1 INGALLS DR
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City | HARVEY
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State | IL
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Zip | 60426-3558
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Country | US
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Telephone | 708-799-5337
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Fax |
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Provider Business Mailing Address
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Address Line | 1743 HEATHER HILL CRES
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2041
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Country | US
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Telephone | 708-799-5337
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Fax | 630-321-0909
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSHIL A SHETH
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Credential | MD
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Telephone | 708-799-5337
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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 | 036081476
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License Number State | IL
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