Organization
Y.M.SHAHMDSC
Active
Other names
primary care joliet
Organization subpart
No
Provider details
NPI number
Authorized official
YATIN M SHAH M.D. (PHYSICIAN/OWNER)
(815) 726-2200
Entity
Organization
Contact information
Practice address
2025 S CHICAGO ST, JOLIET, IL 60436-3172
(815) 726-2200
(815) 727-4573
Mailing address
2025 S CHICAGO ST, JOLIET, IL 60436-3172
(815) 726-2200
(815) 727-4573
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036067943
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
989190
MEDICARE GROUP #
IL
Enumeration date
03/05/2009
Last updated
03/05/2009
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