Provider Demographics
NPI:1326081613
Name:SHAH, ASHOK N (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 S COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6113
Mailing Address - Country:US
Mailing Address - Phone:773-651-0200
Mailing Address - Fax:773-651-8968
Practice Address - Street 1:8419 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6113
Practice Address - Country:US
Practice Address - Phone:773-651-0200
Practice Address - Fax:773-651-8968
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054823207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054823Medicaid
IN202260500AMedicaid
IL036054823Medicaid
IN202260500AMedicaid