Organization
SAMIR SHAH M.D.S.C
Active
Organization
SAMIR SHAH M.D.S.C
Active
Other names
SPESCTRUM CARDIOVASCULAR DIAGNOSTICS
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIR K SHAH M.D. (PRESIDENT)
(708) 425-7660
Entity
Organization
Contact information
Practice address
3560 W 95TH ST, EVERGREEN PARK, IL 60805-2107
(708) 425-7660
Mailing address
3560 W 95TH ST, EVERGREEN PARK, IL 60805-2107
(708) 425-7660
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
036-063403
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036-063403
IL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
036-063403
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636052
BCBS
IL
05
—
036063403
—
IL
Enumeration date
07/26/2006
Last updated
02/12/2014
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