Organization
ST LOUIS SINUS & SLEEP CENTERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN A SHAH M.D. (OWNER)
(618) 939-4368
Entity
Organization
Contact information
Practice address
509 HAMACHER ST, SUITE 205, WATERLOO, IL 62298-1592
(618) 939-4368
(888) 371-4468
Mailing address
1167 FORTUNE BLVD, SHILOH, IL 62269-7377
(618) 628-0715
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
036101869
IL
Other
Enumeration date
05/16/2013
Last updated
05/16/2013
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