MEDICARE: DR. NIRMALA 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	207R00000X	Internal Medicine Physician	036058416	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215930128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIRMALA A. SHAH M.D.

Provider Business Mailing Address
First Line	:	5508 MAIN ST
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6352 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1213
Country	:	US
Telephone Number	:	773-539-5100
Fax Number	:	773-539-7508

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/29/2024

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