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General NPI Number Information
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NPI Number | 1811080716
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Entity Type | Individual
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Provider Name | MANZOOR HUSSAIN SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 1479 RING RD
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City | CALUMET CITY
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State | IL
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Zip | 60409
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Country | US
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Telephone | 708-891-2181
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Fax | 708-891-2188
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Provider Business Mailing Address
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Address Line | 1479 RING RD
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City | CALUMET CITY
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State | IL
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Zip | 60409
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Country | US
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Telephone | 708-891-2181
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Fax | 708-891-2188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036 049259
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 01031445
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License Number State | IN
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