Provider Demographics
NPI:1407830987
Name:SHAH, RANCHHODLAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:RANCHHODLAL
Middle Name:S
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-252-3113
Mailing Address - Fax:773-252-3171
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 340
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-252-3113
Practice Address - Fax:773-252-3171
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048098207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL483401Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ILD89252Medicare UPIN