Provider Demographics
NPI:1518931906
Name:SHAH, SUBHASH K (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHASH
Middle Name:K
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-0206
Mailing Address - Country:US
Mailing Address - Phone:312-567-5560
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:11413 BURR OAK LN
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8008
Practice Address - Country:US
Practice Address - Phone:312-567-5560
Practice Address - Fax:773-337-9106
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051531225400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01619136OtherBC/BS PROVIDER #
ILD93958Medicare UPIN
IL01619136OtherBC/BS PROVIDER #