Individual
MR. KUMUDCHANDRA S SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17680 S KEDZIE AVE, SUITE 201, HAZEL CREST, IL 60429-2043
(708) 799-5420
(708) 799-4093
Mailing address
17680 S KEDZIE AVE, SUITE 201, HAZEL CREST, IL 60429-2043
(708) 799-5420
(708) 799-4093
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036048096
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036048096
—
IL
01
—
21605584
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/30/2006
Last updated
01/24/2012
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