Organization
UDAY SHAH MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. UDAY SHAH MD (PRESIDENT)
(773) 221-4645
Entity
Organization
Contact information
Practice address
9133 S STONY ISLAND AVE, CHICAGO, IL 60617-3936
(773) 221-4645
(773) 221-4849
Mailing address
9133 S STONY ISLAND AVE, CHICAGO, IL 60617-3936
(773) 221-4645
(773) 221-4849
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036057749
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000326579
BLUE CROSS BLUE SHIELD
IN
05
—
036057749
—
IL
01
—
060001645
RAILROAD MEDICARE
—
05
—
200074090B
—
IN
01
—
31600160
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/10/2007
Last updated
09/19/2012
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