Provider Demographics
NPI:1215191630
Name:MANZOOR HUSSAIN SHAH M.D.S.C
Entity Type:Organization
Organization Name:MANZOOR HUSSAIN SHAH M.D.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANZOOR
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-921-1697
Mailing Address - Street 1:1479 RING RD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5459
Mailing Address - Country:US
Mailing Address - Phone:708-891-2181
Mailing Address - Fax:
Practice Address - Street 1:1479 RING RD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5459
Practice Address - Country:US
Practice Address - Phone:708-891-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049259207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021626973OtherBLUE CROSS /BLUE SHIELD
IL791061547AOtherRAIL ROAD MEDICARE
IL036049259Medicaid
ILD13137Medicare UPIN
IL791061547AOtherRAIL ROAD MEDICARE