Individual
SUDHA V. SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1516 W DEVON AVE, CHICAGO, IL 60660-1314
(773) 465-7889
(773) 465-7615
Mailing address
1516 W DEVON AVE, CHICAGO, IL 60660-1314
(773) 465-7889
(773) 465-7615
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
036060895
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060895
—
IL
Enumeration date
08/05/2006
Last updated
07/08/2007
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