Individual
INDIRA SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2526 N LINCOLN AVE, CHICAGO, IL 60614-2353
(773) 929-7410
Mailing address
75 REMITTANCE DR DEPT 1704, CHICAGO, IL 60675-1704
(727) 823-2188
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36057975
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110008973
RAILROAD MEDICARE
—
01
—
31600190
BCBS
IL
Enumeration date
07/31/2006
Last updated
09/25/2012
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