Individual
DR. MANTHAN RAJESH SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, LOYOLA OUTPATIENT CENTER 4200, MAYWOOD, IL 60153-3328
(708) 216-3833
(708) 216-2778
Mailing address
7447 W TALCOTT AVE, STE 345, CHICAGO, IL 60631-3714
(708) 216-3833
(708) 216-2778
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036140120
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
036140120
IL
Other
Enumeration date
05/17/2011
Last updated
12/30/2021
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