Provider Demographics
NPI:1235362773
Name:SHAH, RUTH SUBHASH (ANP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:SUBHASH
Last Name:SHAH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:FAMILY HEALTH CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-2128
Mailing Address - Fax:312-328-7702
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:FAMILY HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2128
Practice Address - Fax:312-328-7702
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBSIL
IL950150OtherMEDICARE GROUP #
IL950150OtherMEDICARE GROUP #