Organization
SHETH SUSHIL A MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSHIL A SHETH MD (PRESIDENT)
(708) 799-5337
Entity
Organization
Contact information
Practice address
1 INGALLS DR, HARVEY, IL 60426-3558
(708) 799-5337
Mailing address
1743 HEATHER HILL CRES, FLOSSMOOR, IL 60422-2041
(708) 799-5337
(630) 321-0909
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036081476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036081476
—
IL
01
—
1626060
BLUE SHIELD
IL
Enumeration date
10/12/2006
Last updated
12/30/2008
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