Provider Demographics
NPI:1427019686
Name:SUBHASH SHAH MD SC
Entity Type:Organization
Organization Name:SUBHASH SHAH MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-567-5560
Mailing Address - Street 1:11413 BURR OAK LN
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8008
Mailing Address - Country:US
Mailing Address - Phone:312-567-5560
Mailing Address - Fax:312-328-7732
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-5560
Practice Address - Fax:312-328-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051531225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215324OtherBCBS PROVIDER #
IL036051531 3OtherPUBLIC AID PROVIDER #
IL930570Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL036051531 3OtherPUBLIC AID PROVIDER #