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Organization
MAYFAIR FAMILYCARE SC
Active
Organization
MAYFAIR FAMILYCARE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHARAT KANTILAL SHAH M.D. (PRESIDENT)
(773) 271-6622
Entity
Organization
Contact information
Practice address
5115 N FRANCISCO AVE, FL 1, CHICAGO, IL 60625-3611
(773) 271-6622
(773) 271-6801
Mailing address
5115 N FRANCISCO AVE, FL 1, CHICAGO, IL 60625-3611
(773) 271-6622
(773) 271-6801
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042007954
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110169119
RAILROAD MEDICARE
—
01
—
21605075
BLUE CROSS
IL
Enumeration date
05/19/2006
Last updated
01/10/2015
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