Provider Demographics
NPI:1114928884
Name:SHAH, CHANDRIKA (PA)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRIKA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 51ST ST
Mailing Address - Street 2:PROVIDENT HOSPITAL OF COOK COUNTY, DEPT OF SURGERY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2400
Mailing Address - Country:US
Mailing Address - Phone:312-572-2664
Mailing Address - Fax:312-572-2681
Practice Address - Street 1:500 E 51ST STREET
Practice Address - Street 2:PROVIDENT HOSPITAL OF COOK COUNTY DEPT OF GEN SURGERY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:312-572-2664
Practice Address - Fax:312-572-2681
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001953363A00000X
ILMS0930241363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical