Provider Demographics
NPI:1306019203
Name:SHAI HILLS MEDICAL & DIAGNOSTIC GROUP, LTD
Entity Type:Organization
Organization Name:SHAI HILLS MEDICAL & DIAGNOSTIC GROUP, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACQUAYE-AWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-807-0555
Mailing Address - Street 1:PO BOX 7151
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-7151
Mailing Address - Country:US
Mailing Address - Phone:773-807-0555
Mailing Address - Fax:
Practice Address - Street 1:5517 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1012
Practice Address - Country:US
Practice Address - Phone:773-643-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty