MEDICARE: SHAI HILLS MEDICAL & DIAGNOSTIC GROUP, LTD

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	036102126	IL

General Provider Information

NPI Number	:	1306019203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAI HILLS MEDICAL & DIAGNOSTIC GROUP, LTD

Provider Business Mailing Address
First Line	:	PO BOX 7151
Second Line	:
City	:	WESTCHESTER
State	:	IL
Zip	:	60154-7151
Country	:	US
Telephone Number	:	773-807-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	5517 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1012
Country	:	US
Telephone Number	:	773-643-4428
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN ACQUAYE-AWAH
Credential	:	MD
Telephone Number	:	773-807-0555

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	05/28/2008

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