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General NPI Number Information
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NPI Number | 1881600187
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Entity Type | Individual
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Provider Name | INDIRA SHAH
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 2526 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-2353
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Country | US
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Telephone | 773-929-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 75 REMITTANCE DR DEPT 1704
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City | CHICAGO
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State | IL
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Zip | 60675-1704
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Country | US
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Telephone | 727-823-2188
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36057975
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License Number State | IL
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