Individual
ILA SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8419 S COTTAGE GROVE AVE, CHICAGO, IL 60619-6113
(773) 651-0200
(773) 651-8968
Mailing address
8419 S COTTAGE GROVE AVE, CHICAGO, IL 60619-6113
(773) 651-0200
(773) 651-8968
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0104012B
IN
207Q00000X
Family Medicine Physician
Primary
036061434
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036061434
—
IL
01
—
21609496
BCBS
IL
Enumeration date
06/29/2006
Last updated
01/09/2014
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