MEDICARE: NORTH SUBURBAN PULMONARY & CRITICAL CARE CONSULTANTS, S.C.

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	207RP1001X	Pulmonary Disease Physician	042617267	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	042617267	IL

General Provider Information

NPI Number	:	1083681431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SUBURBAN PULMONARY & CRITICAL CARE CONSULTANTS, S.C.

Provider Business Mailing Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053
Country	:	US
Telephone Number	:	847-759-4770
Fax Number	:	847-759-8824

Provider Business Practice Location Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2102
Country	:	US
Telephone Number	:	847-759-4770
Fax Number	:	847-759-8824

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BHAVEN SHAH
Credential	:	M.D.
Telephone Number	:	847-759-4770

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	12/17/2021

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