Individual
AKTA DINESH SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
3703 W LAKE AVE, SUITE #200, GLENVIEW, IL 60026-1223
(847) 998-1188
Mailing address
3703 W LAKE AVE, SUITE #200, GLENVIEW, IL 60026-1223
(847) 998-1188
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
070-012688
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634372
BCBS GROUP NO.
IL
01
—
1618443
BCBS GROUP NO.
IL
01
—
200573902
GROUP TAX ID
IL
05
—
236963283001
—
IL
01
—
363396874
GROUP TAX ID
IL
Enumeration date
07/20/2006
Last updated
08/18/2015
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