MEDICARE: ASHOK C SHAH MDPC

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	036064449	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	:	1790079234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHOK C SHAH MDPC

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	:	M.D
Name	:	ASHOK C SHAH
Credential	:
Telephone Number	:	773-769-3338

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	06/01/2011

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