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General NPI Number Information
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NPI Number | 1982907085
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Entity Type | Organization
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Legal Business Name | SHANKAR DAS MD SC
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 4257 N CENTRAL PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60618-2019
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Country | US
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Telephone | 847-502-4156
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Fax |
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Provider Business Mailing Address
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Address Line | 4257 N CENTRAL PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60618-2019
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Country | US
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Telephone | 847-502-4156
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHANKAR DAS
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Credential | MD
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Telephone | 847-502-4156
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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 | 036119559
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License Number State | IL
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