Individual
DR. SUBHASH K SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11413 BURR OAK LN, BURR RIDGE, IL 60527-8008
(312) 567-5560
(773) 337-9106
Mailing address
PO BOX 206, WILLOW SPRINGS, IL 60480-0206
(312) 567-5560
(773) 337-9106
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036051531
IL
225400000X
Rehabilitation Practitioner
Primary
036051531
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01619136
BC/BS PROVIDER #
IL
Enumeration date
02/14/2006
Last updated
03/31/2014
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