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General NPI Number Information
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NPI Number | 1992961494
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Entity Type | Individual
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Provider Name | SAMIR RAJENDRA SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 737 W WASHINGTON BLVD UNIT 3007
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City | CHICAGO
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State | IL
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Zip | 60661-2173
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Country | US
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Telephone | 312-589-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 737 W WASHINGTON BLVD UNIT 3007
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City | CHICAGO
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State | IL
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Zip | 60661-2173
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Country | US
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Telephone | 312-589-1002
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 036.120651
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License Number State | IL
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