Individual
DR. MANOJ SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1875 DEMPSTER ST, SUITE 280, PARK RIDGE, IL 60068-1186
(847) 318-9071
(847) 318-2535
Mailing address
1875 DEMPSTER ST, SUITE 280, PARK RIDGE, IL 60068-1186
(847) 318-9071
(847) 318-2535
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036068794
IL
2086S0102X
Surgical Critical Care Physician
036068794
IL
2086S0127X
Trauma Surgery Physician
036068794
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036068794
—
IL
Enumeration date
08/19/2006
Last updated
12/20/2021
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