Organization
ONE MAG MILE ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BHAGWAN T SHAHANI M.D. (PRESIDENT)
(312) 587-9123
Entity
Organization
Contact information
Practice address
11012 S WESTERN AVE, CHICAGO, IL 60643
(773) 238-5300
(773) 238-5343
Mailing address
950 N MICHIGAN AVE, SUITE 4305, CHICAGO, IL 60611-4509
(312) 587-9123
(312) 944-4954
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1635370
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/04/2007
Last updated
08/22/2020
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