Provider Demographics
NPI:1093776460
Name:SHA, BEVERLY E (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:E
Last Name:SHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S PAULINA ST STE 140AAC
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-5865
Mailing Address - Fax:312-942-2184
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:SUITE 143
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-5865
Practice Address - Fax:312-942-2184
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-075746207R00000X
IL036075746207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL440003645OtherRR MEDICARE
IL036075746Medicaid
ILL73834Medicare PIN
IL440003645OtherRR MEDICARE