MEDICARE: DR. SHIVANG MANOJ SHAH DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016.005954	IL

General Provider Information

NPI Number	:	1316444524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIVANG MANOJ SHAH DPM

Provider Business Mailing Address
First Line	:	1624 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1214
Country	:	US
Telephone Number	:	773-769-3338
Fax Number	:	773-769-5568

Provider Business Practice Location Address
First Line	:	1624 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1214
Country	:	US
Telephone Number	:	773-769-3338
Fax Number	:	773-769-5568

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	12/22/2021

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