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Individual
DR. MIRAB MICKEY SHAH
Active
Individual
DR. MIRAB MICKEY SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070013727
IL
261QP2000X
Physical Therapy Clinic/Center
060010072
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP
IL
01
—
567700
MEDICARE GROUP NUMBER
IL
01
—
568080
MEDICARE GROUP NUMBER
IL
01
—
568150
MEDICARE GROUP NUMBER
IL
Enumeration date
04/10/2008
Last updated
08/01/2024
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