Organization
SUBHASH SHAH MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUBHASH K SHAH MD (OWNER)
(312) 567-5560
Entity
Organization
Contact information
Practice address
2525 S MICHIGAN AVE, CHICAGO, IL 60616-2333
(312) 567-5560
(312) 328-7732
Mailing address
11413 BURR OAK LN, BURR RIDGE, IL 60527-8008
(312) 567-5560
(312) 328-7732
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
036051531
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02215324
BCBS PROVIDER #
IL
01
—
036051531 3
PUBLIC AID PROVIDER #
IL
Enumeration date
03/29/2006
Last updated
05/07/2012
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