Individual
MATTHEW Q SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(847) 466-4357
Mailing address
10330 N MERIDIAN ST # 300, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01057807A
IN
207L00000X
Anesthesiology Physician
Primary
036.163903
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001078292
ANTHEM PROVIDER NUMBER
IN
05
—
200522650
—
IN
Enumeration date
02/19/2007
Last updated
08/15/2023
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