MEDICARE: LEROY OAKS FAMILY MEDICINE, P.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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1487727152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEROY OAKS FAMILY MEDICINE, P.C.

Provider Business Mailing Address
First Line	:	2435 DEAN STREET
Second Line	:	SUITE C
City	:	ST. CHARLES
State	:	IL
Zip	:	60175
Country	:	US
Telephone Number	:	630-377-8880
Fax Number	:	630-485-5129

Provider Business Practice Location Address
First Line	:	2435 DEAN STREET
Second Line	:	SUITE C
City	:	ST. CHARLES
State	:	IL
Zip	:	60175
Country	:	US
Telephone Number	:	630-377-8880
Fax Number	:	630-485-5129

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BHAVESH A SHAH
Credential	:	M.D.
Telephone Number	:	630-377-8880

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	02/26/2008

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