Organization
MANZOOR HUSSAIN SHAH M.D.S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANZOOR HUSSAIN SHAH M.D (PRESIDENT)
(708) 921-1697
Entity
Organization
Contact information
Practice address
1479 RING RD, CALUMET CITY, IL 60409-5459
(708) 891-2181
Mailing address
1479 RING RD, CALUMET CITY, IL 60409-5459
(708) 891-2181
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036049259
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021626973
BLUE CROSS /BLUE SHIELD
IL
05
—
036049259
—
IL
01
—
791061547A
RAIL ROAD MEDICARE
IL
Enumeration date
07/15/2008
Last updated
08/11/2008
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