MEDICARE: NISHANT A SHAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	036131644	IL
2	207L00000X	Anesthesiology Physician	036.131644	IL

General Provider Information

NPI Number	:	1043412992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHANT A SHAH M.D.

Provider Business Mailing Address
First Line	:	820 S. DAMEN AVENUE
Second Line	:	ANESTHESIOLOGY SERVICE ROOM 2672
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	312-569-6750
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S. DAMEN AVENUE
Second Line	:	ANESTHESIOLOGY SERVICE ROOM 2672
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	312-569-6750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/13/2023

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