Provider Demographics
NPI:1043419328
Name:UPENDRA C. SHAH MDSC
Entity Type:Organization
Organization Name:UPENDRA C. SHAH MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UPENDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-631-8474
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE # 444
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-8474
Mailing Address - Fax:773-631-4180
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE # 444
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-8474
Practice Address - Fax:773-631-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
036057815207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031620707OtherBLUE CROSS BLUE SHIELD
IL036057815Medicaid
IL0031600707OtherBLUE CROSS BLUE SHIELD
IL0031600707OtherBLUE CROSS BLUE SHIELD
IL717461Medicare PIN
IL0031620707OtherBLUE CROSS BLUE SHIELD