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General NPI Number Information
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NPI Number | 1811905185
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Entity Type | Organization
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Legal Business Name | A. N. SHAH MD SC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 2315 E 93RD ST STE 340
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City | CHICAGO
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State | IL
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Zip | 60617-3948
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Country | US
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Telephone | 773-468-9000
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Fax | 847-587-6113
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Provider Business Mailing Address
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Address Line | 3040 SCOTT CRES
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1728
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Country | US
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Telephone | 773-468-9000
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Fax | 847-587-6113
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Authorized Official
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Title or Position | OWNER
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Name | ASHVIN N SHAH
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Credential | MD
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Telephone | 773-468-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036058180
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License Number State | IL
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