Individual
PRABODH C SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 W 95TH ST, CANCER CENTER, EVERGREEN PARK, IL 60805-2701
(708) 229-6020
(708) 229-6083
Mailing address
2800 W 95TH ST, CANCER CENTER, EVERGREEN PARK, IL 60805-2701
(708) 229-6020
(708) 229-6083
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036042091
IL
207RH0003X
Hematology & Oncology Physician
A25747
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A257470
—
CA
01
—
036042091
LICENSE
IL
05
—
036042091
—
IL
01
—
M050376
GROUP
CA
Enumeration date
10/13/2005
Last updated
06/23/2014
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