MEDICARE: PAYAL KIRTIKANT 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	207RI0200X	Infectious Disease Physician	A124454	CA
2	207R00000X	Internal Medicine Physician	125057424	IL

General Provider Information

NPI Number	:	1760791198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYAL KIRTIKANT SHAH M.D.

Provider Business Mailing Address
First Line	:	425 W SURF ST
Second Line	:	UNIT 114
City	:	CHICAGO
State	:	IL
Zip	:	60657-6450
Country	:	US
Telephone Number	:	302-682-5467
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 N LAKE SHORE DR
Second Line	:	ST JOSPEH HOSPITAL
City	:	CHICAGO
State	:	IL
Zip	:	60657-6232
Country	:	US
Telephone Number	:	773-665-5041
Fax Number	:

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

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	11/29/2018

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